Assessing expectancy and suggestibility in a trial of escitalopram v. psilocybin for depression

BACKGROUND

To investigate the association between pre-trial expectancy, suggestibility, and response to treatment in a trial of escitalopram and investigational drug, COMP360, psilocybin, in the treatment of major depressive disorder (ClinicalTrials.gov registration: NCT03429075).

METHODS

We used data (n = 55) from our recent double-blind, parallel-group, randomized head-to-head comparison trial of escitalopram and investigational drug, COMP360, psilocybin. Mixed linear models were used to investigate the association between pre-treatment efficacy-related expectations, as well as baseline trait suggestibility and absorption, and therapeutic response to both escitalopram and COMP360 psilocybin.

RESULTS

Patients had significantly higher expectancy for psilocybin relative to escitalopram; however, expectancy for escitalopram was associated with improved therapeutic outcomes to escitalopram, expectancy for psilocybin was not predictive of response to psilocybin. Separately, we found that pre-treatment trait suggestibility was associated with therapeutic response in the psilocybin arm, but not in the escitalopram arm.

CONCLUSIONS

Overall, our results suggest that psychedelic therapy may be less vulnerable to expectancy biases than previously suspected. The relationship between baseline trait suggestibility and response to psilocybin therapy implies that highly suggestible individuals may be primed for response to this treatment.

Psychiatric risks for worsened mental health after psychedelic use

BACKGROUND

Resurgent psychedelic research has largely supported the safety and efficacy of psychedelic therapy for the treatment of various psychiatric disorders. As psychedelic use and therapy increase in prevalence, so does the importance of understanding associated risks. Cases of prolonged negative psychological responses to psychedelic therapy seem to be rare; however, studies are limited by biases and small sample sizes. The current analytical approach was motivated by the question of whether rare but significant adverse effects have been under-sampled in psychedelic research studies.

METHODS

A "bottom margin analysis" approach was taken to focus on negative responders to psychedelic use in a pool of naturalistic, observational prospective studies (N = 807). We define "negative response" by a clinically meaningful decline in a generic index of mental health, that is, one standard error from the mean decrease in psychological well-being 4 weeks post-psychedelic use (vs pre-use baseline). We then assessed whether a history of diagnosed mental illness can predict negative responses.

RESULTS

We find that 16% of the cohort falls into the "negative responder" subset. Parsing the sample by self-reported history of psychiatric diagnoses, results revealed a disproportionate prevalence of negative responses among those reporting a prior personality disorder diagnosis (31%). One multivariate regression model indicated a greater than four-fold elevated risk of adverse psychological responses to psychedelics in the personality disorder subsample (b = 1.425, p < 0.05).

CONCLUSION

We infer that the presence of a personality disorder may represent an elevated risk for psychedelic use and hypothesize that the importance of psychological support and good therapeutic alliance may be increased in this population.

Who are you after psychedelics? A systematic review and a meta-analysis of the magnitude of long-term effects of serotonergic psychedelics on cognition/creativity, emotional processing and personality

This systematic review and a meta-analysis synthesised the results from contemporary, randomized and non-randomized controlled studies to assess lasting (one week minimum) changes on cognition/creativity, emotional processing and personality from serotonergic psychedelics. PubMed, Embase and PsycInfo were searched in July 2022. Risk of bias was assessed using Rob 2.0 and ROBINS-I. Ten studies met the eligibility criteria which involved 304 participants. No statistically significant effects were found for the majority outcome measures across the three constructs. A meta-analysis of emotional recognition outcomes found an overall significant effect for faster reaction times in the active treatment groups for disgust (SMD=-0.63, 95% CI=[-1.01 to -0.25], I2 = 65%) and sadness (SMD=-0.45, 95% CI=[-0.85 to -0.06], I2 = 60%). Future research should include larger samples, better control conditions, standardized doses and longer follow-up periods to confirm these preliminary findings.

Preliminary evidence for the importance of therapeutic alliance in MDMA-assisted psychotherapy for posttraumatic stress disorder

Background: MDMA-assisted psychotherapy (MDMA-AP) is a combined psychotherapeutic and pharmacologic intervention that shows promise in the treatment of posttraumatic stress disorder (PTSD). Although therapeutic alliance has been established as a key predictor across psychotherapies and is emphasised within MDMA-AP treatment manuals, research has not yet examined the relationship between therapeutic alliance and MDMA-AP treatment outcomes.Objective: Examine whether therapeutic alliance predicts changes in PTSD symptoms following MDMA-AP.Method: Twenty-three individuals with chronic PTSD participated in a MDMA-AP clinical trial that included a randomised (MDMA vs. placebo) and open-label phase. The present analyses focused on participants who were administered MDMA over the course of the randomised and open-label phases (n = 22). Therapeutic alliance was assessed using the Working Alliance Inventory at sessions baseline (pre-session 3) and sessions 4 and 9. PTSD symptoms were assessed using the Clinician Administered PTSD Scale and the Impact of Events Scale-Revised.Results: Controlling for baseline clinician-assessed PTSD severity, therapeutic alliance at sessions 4 and 9 (but not baseline) significantly predicted post-MDMA-AP clinician-assessed PTSD severity. Controlling for baseline self-reported PTSD severity, therapeutic alliance at baseline (although this did not survive correction for multiple comparisons) and sessions 4 and 9 predicted post-MDMA-AP self-reported PTSD severity.Conclusions: The present results provide the first preliminary evidence for the relationship between the therapeutic alliance and treatment outcomes within MDMA-AP for PTSD. These findings highlight the important role of psychotherapy, and common psychotherapeutic factors, within MDMA-AP. Replication in studies with larger and more diverse clinical samples remain necessary.Trial registration: ClinicalTrials.gov identifier: NCT00090064.

Personality change in a trial of psilocybin therapy v. escitalopram treatment for depression

BACKGROUND

Psilocybin Therapy (PT) is being increasingly studied as a psychiatric intervention. Personality relates to mental health and can be used to probe the nature of PT's therapeutic action.

METHODS

In a phase 2, double-blind, randomized, active comparator controlled trial involving patients with moderate-to-severe major depressive disorder, we compared psilocybin with escitalopram, over a core 6-week trial period. Five-Factor model personality domains, Big Five Aspect Scale Openness aspects, Absorption, and Impulsivity were measured at Baseline, Week 6, and Month 6 follow-up.

RESULTS

PT was associated with decreases in neuroticism (B = -0.63), introversion (B = -0.38), disagreeableness (B = -0.47), impulsivity (B = -0.40), and increases in absorption (B = 0.32), conscientiousness (B = 0.30), and openness (B = 0.23) at week 6, with neuroticism (B = -0.47) and disagreeableness (B = -0.41) remaining decreased at month 6. Escitalopram Treatment (ET) was associated with decreases in neuroticism (B = -0.38), disagreeableness (B = -0.26), impulsivity (B = -0.35), and increases in openness (B = 0.28) at week 6, with neuroticism (B = -0.46) remaining decreased at month 6. No significant between-condition differences were observed.

CONCLUSIONS

Personality changes across both conditions were in a direction consistent with improved mental health. With the possible exception of trait absorption, there were no compelling between-condition differences warranting conclusions regarding a selective action of PT (v. ET) on personality; however, post-ET changes in personality were significantly moderated by pre-trial positive expectancy for escitalopram, whereas expectancy did not moderate response to PT.

Ayahuasca in the treatment of posttraumatic stress disorder: Mixed-methods case series evaluation in military combat veterans

OBJECTIVE

Although ayahuasca-a plant-based psychedelic-is discussed as promising in the treatment of posttraumatic stress disorder (PTSD), evidence so far remains limited to retrospective case reports and qualitative surveys. No study to date has examined whether ayahuasca results in prospective and clinically meaningful changes in trauma symptoms across individuals with PTSD symptoms.

METHOD

To address this gap, we conducted a convergent mixed-methods case series study on eight military veterans with PTSD who participated in a 3-day ayahuasca intervention in Central America. Clinically meaningful changes from pre- to posttreatment and at a 3-month follow-up were assessed in three ways using: (a) PTSD checklist-5 (PCL-5); (b) experience sampling measurement of momentary PTSD and mood symptoms; and (c) an open-ended survey on perceived benefits.

RESULTS

The majority (87.5%; 7/8) of participants demonstrated reliable and/or clinically significant changes in PCL-5 symptoms by posttreatment, which were maintained by 70% (5/7) of veterans by the 3-month follow-up. On average, veterans also reported significant improvements in momentary PTSD symptoms, as well as negative and positive affect in daily life posttreatment, with 63% (5/8) reporting moderate-to-large improvements in these domains. Broad themes characterizing the perceived benefits of ayahuasca included deep positive emotions, decentering/acceptance, and purpose in life; adverse acute experiences were, however, reported.

CONCLUSIONS

This study provides preliminary support for the clinically meaningful and lasting benefits of a brief ayahuasca intervention on PTSD/mood symptoms in military veterans. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psilocybin and Other Classic Psychedelics in Depression

Psychedelic drugs such as psilocybin and ketamine are returning to clinical research and intervention across several disorders including the treatment of depression. This chapter focusses on psychedelics that specifically target the 5-HT2A receptor such as psilocybin and DMT. These produce plasma-concentration related psychological effects such as hallucinations and out of body experiences, insightful and emotional breakthroughs as well as mystical-type experiences. When coupled with psychological support, effects can produce a rapid improvement in mood among people with depression that can last for months. In this chapter, we summarise the scientific studies to date that explore the use of psychedelics in depressed individuals, highlighting key clinical, psychological and neuroimaging features of psychedelics that may account for their therapeutic effects. These include alterations in brain entropy that disrupt fixed negative ruminations, a period of post-treatment increased cognitive flexibility, and changes in self-referential psychological processes. Finally, we propose that the brain mechanisms underlying the therapeutic effect of serotonergic psychedelics might be distinct from those underlying classical serotonin reuptake-blocking antidepressants.

Increasing character strength knowledge, interest, and skill: preliminary evidence for a collaborative and multimethod assessment procedure

Introduction

The study's objective was to evaluate whether a qualitative, collaborative, and multimethod assessment protocol increased reports of character strength interest, knowledge, and perceived skills.

Methods

Thirty-two participants completed three phases of data collection. Participants were first screened for well-being, which was used as an auxiliary covariate to order participants into experimental conditions. Selected participants were randomly assigned to a control or collaborative and multimethod assessment (card sort × qualitative interview) condition. Participants completed pre- and post-measures of strength interest, knowledge, and perceived skill. In the final phase, second phase participants were invited to report on strength-related outcomes 24 h post-administration using an online survey.

Results

A series of 2 (Assessment Condition) × 3 (Time) mixed ANOVAs were analyzed. Results revealed a significant assessment condition by time interaction for strength knowledge and perceived skill. Participants in the collaborative and multimethod assessment condition reported higher strength knowledge and perceived skills compared to control participants. These effects were maintained for 24 h.

Conclusion

The findings offer preliminary yet sizable support for using collaborative and multimethod assessment procedures to increase strength knowledge and perceived skill. Because of the qualitative, collaborative, and individualized nature of our assessment protocol, the findings offer a low-cost and contextually bound pathway to increase strength-based outcomes.

A critical evaluation of QIDS-SR-16 using data from a trial of psilocybin therapy versus escitalopram treatment for depression

BACKGROUND

In a recent clinical trial examining the comparative efficacy of psilocybin therapy (PT) versus escitalopram treatment (ET) for major depressive disorder, 14 of 16 major efficacy outcome measures yielded results that favored PT, but the Quick Inventory of Depressive Symptomatology, Self-Report, 16 items (QIDS-SR16) did not.

AIMS

The present study aims to (1) rationally and psychometrically account for discrepant results between outcome measures and (2) to overcome psychometric problems particular to individual measures by re-examining between-condition differences in depressive response using all outcome measures at item-, facet-, and factor-levels of analysis.

METHOD

Four depression measures were compared on the basis of their validity for examining differences in depressive response between PT and ET conditions.

RESULTS/OUTCOMES

Possible reasons for discrepant findings on the QIDS-SR16 include its higher variance, imprecision due to compound items and whole-scale and unidimensional sum-scoring, vagueness in the phrasing of scoring options for items, and its lack of focus on a core depression factor. Reanalyzing the trial data at item-, facet-, and factor-levels yielded results suggestive of PT's superior efficacy in reducing depressed mood, anhedonia, and a core depression factor, along with specific symptoms such as sexual dysfunction.

CONCLUSION/INTERPRETATION

Our results raise concerns about the adequacy of the QIDS-SR16 for measuring depression, as well as the practice of relying on individual scales that tend not to capture the multidimensional structure or core of depression. Using an alternative approach that captures depression more granularly and comprehensively yielded specific insight into areas where PT therapy may be particularly useful to patients and clinicians.

Prevalence and therapeutic impact of adverse life event reexperiencing under ceremonial ayahuasca

The present study examined the safety and efficacy of the ceremonial use of ayahuasca in relation to reports of heightened life event reexperiencing under psychedelics. The study examined (1) the prevalence of specific types of adverse life event reexperiencing, (2) characteristics predictive of reexperiencing, (3) the psychological character of reexperiencing, and (4) the impact of reexperiencing on mental health. Participants were recruited from three ayahuasca healing and spiritual centers in South and Central America (N = 33 military veterans, 306 non-veterans) using self-report data at three timepoints (Pre-retreat, Post-retreat, 3-months post-retreat). Reexperiencing adverse life events under ayahuasca was common, with women showing particularly high probability of reexperiencing sexual assault, veterans reexperiencing combat-related trauma, and individuals with a self-reported lifetime diagnosis of post-traumatic stress disorder exhibiting a substantively higher prevalence of reexperiencing. Reexperiencing was associated with states of cognitive reappraisal, psychological flexibility, and discomfort during ceremonies, and participants who reexperienced adverse life events exhibited greater reductions in trait neuroticism following their ceremonies. Clinical implications of these results for the application of psychedelics to mood and stress disorders are discussed.

Examining the Therapeutic Effect of Ceremonial Ayahuasca on Narcissistic Personality and Antagonistic Externalizing in Adults

Changes in narcissistic traits (e.g., entitlement) following the ceremonial use of ayahuasca were examined across three timepoints (baseline, postretreat, 3-month follow-up) in a sample of 314 adults using self- and informant-report (N = 110) measures. Following ceremonial use of ayahuasca, self-reported changes in narcissism were observed (i.e., decreases in Narcissistic Personality Inventory [NPI] Entitlement-Exploitativeness, increases in NPI Leadership Authority, decreases in a proxy measure of narcissistic personality disorder [NPD]). However, effect size changes were small, results were somewhat mixed across convergent measures, and no significant changes were observed by informants. The present study provides modest and qualified support for adaptive change in narcissistic antagonism up to 3 months following ceremony experiences, suggesting some potential for treatment efficacy. However, meaningful changes in narcissism were not observed. More research would be needed to adequately evaluate the relevance of psychedelic-assisted therapy for narcissistic traits, particularly studies examining individuals with higher antagonism and involving antagonism-focused therapeutic approaches.

Canalization and plasticity in psychopathology

This theoretical article revives a classical bridging construct, canalization, to describe a new model of a general factor of psychopathology. To achieve this, we have distinguished between two types of plasticity, an early one that we call 'TEMP' for 'Temperature or Entropy Mediated Plasticity', and another, we call 'canalization', which is close to Hebbian plasticity. These two forms of plasticity can be most easily distinguished by their relationship to 'precision' or inverse variance; TEMP relates to increased model variance or decreased precision, whereas the opposite is true for canalization. TEMP also subsumes increased learning rate, (Ising) temperature and entropy. Dictionary definitions of 'plasticity' describe it as the property of being easily shaped or molded; TEMP is the better match for this. Importantly, we propose that 'pathological' phenotypes develop via mechanisms of canalization or increased model precision, as a defensive response to adversity and associated distress or dysphoria. Our model states that canalization entrenches in psychopathology, narrowing the phenotypic state-space as the agent develops expertise in their pathology. We suggest that TEMP - combined with gently guiding psychological support - can counter canalization. We address questions of whether and when canalization is adaptive versus maladaptive, furnish our model with references to basic and human neuroscience, and offer concrete experiments and measures to test its main hypotheses and implications. This article is part of the Special Issue on "National Institutes of Health Psilocybin Research Speaker Series".

Effectiveness of biofeedback-assisted asynchronous telerehabilitation in musculoskeletal care: A systematic review

Background

Musculoskeletal conditions are the leading cause of disability worldwide. Telerehabilitation may be a viable option in the management of these conditions, facilitating access and patient adherence. Nevertheless, the impact of biofeedback-assisted asynchronous telerehabilitation remains unknown.

Objective

To systematically review and assess the effectiveness of exercise-based asynchronous biofeedback-assisted telerehabilitation on pain and function in individuals with musculoskeletal conditions.

Methods

This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The search was conducted using three databases: PubMed, Scopus, and PEDro. Study criteria included articles written in English and published from January 2017 to August 2022, reporting interventional trials evaluating exercise-based asynchronous telerehabilitation using biofeedback in adults with musculoskeletal disorders. The risks of bias and certainty of evidence were appraised using the Cochrane tool and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE), respectively. The results are narratively summarized, and the effect sizes of the main outcomes were calculated.

Results

Fourteen trials were included: 10 using motion tracker technology (N = 1284) and four with camera-based biofeedback (N = 467). Telerehabilitation with motion trackers yields at least similar improvements in pain and function in people with musculoskeletal conditions (effect sizes: 0.19-1.45; low certainty of evidence). Uncertain evidence exists for the effectiveness of camera-based telerehabilitation (effect sizes: 0.11-0.13; very low evidence). No study found superior results in a control group.

Conclusions

Asynchronous telerehabilitation may be an option in the management of musculoskeletal conditions. Considering its potential for scalability and access democratization, additional high-quality research is needed to address long-term outcomes, comparativeness, and cost-effectiveness and identify treatment responders.

Prospective examination of the therapeutic role of psychological flexibility and cognitive reappraisal in the ceremonial use of ayahuasca

BACKGROUND

Evidence suggests that psychedelic-assisted therapy carries transdiagnostic efficacy in the treatment of mental health conditions characterized by low mood and the use of avoidance coping strategies.

AIMS

While preliminary evidence suggests that psychological flexibility and emotion regulation processes play an important role within psychedelic therapy, this prospective study addressed methodological gaps in the literature and examined the ability of ayahuasca to stimulate acute states of cognitive reappraisal and long-term changes in psychological flexibility and mood. The study also explored whether moderating factors predisposed participants to experience therapeutic changes.

METHODS

Participants (N = 261) were recruited from three Shipibo ayahuasca retreat centers in Central and South America and completed assessments on mood, psychological flexibility, and acute ceremonial factors. Expectancy, demand characteristics, and invalid responding were controlled for with several validity scales.

RESULTS/OUTCOMES

Participants reported significant reductions in negative mood after three months, as well as increases in positive mood and psychological flexibility. Acute experiences of reappraisal during the ayahuasca ceremony exerted the strongest moderating effects on increases in positive mood and psychological flexibility. Increases in psychological flexibility statistically mediated the effects of acute psychological factors, including reappraisal, on changes in positive mood.

CONCLUSIONS/INTERPRETATION

These results highlight the role of acute psychological processes, such as reappraisal, and post-acute increases in psychological flexibility as putative mechanisms underlying positive outcomes associated with psychedelics. These results also provide support for the integration of third-wave and mindfulness-based therapy approaches with psychedelic-assisted interventions.

A221 CONGENITAL PORTOSYSTEMIC SHUNTS: FROM PRENATAL DIAGNOSIS TO LONG- TERM POSTNATAL OUTCOME

Background

Congenital portosystemic shunts (CPSS) are rare vascular malformations that result in blood bypassing the liver and re-entering the systemic circulation unfiltered. The outcomes of CPSS diagnosed prenatally are unknown. Previously published data is related to patients diagnosed after symptom appearance, including hepatic encephalopathy, liver tumors and portal hypertension.

Aims

To describe a cohort of prenatally diagnosed children with CPSS and report on the natural history and outcomes.

Methods

The study was conducted between 2006 and 2019. Prenatal diagnosis was performed during routine prenatal ultrasound. Patients were followed by the pediatric gastroenterologists’ unit.

Results

32 patients were identified; 28 patients with intrahepatic shunts and four patients with extrahepatic shunts. During follow up, Failure to Thrive (FTT) was observed in three of the patients with one shunt (16.7%), and five of the patients with two shunts or more (55.6%). The difference is significant (p- value=0.037). 24 patients with intrahepatic shunts had their shunts closed spontaneously. Median time for closure of the shunt was seven months (IQR 2–14 months, range 0–35 months). No predicting factor was detected for closure of the shunt before the age of one year. All extrahepatic shunts required surgical closure.

Conclusions

Congenital intrahepatic shunts usually close spontaneously and do not need intervention. All patients in our prenatally diagnosed cohort survived with limited to no sequelae.

Funding Agencies

None

Examining Psychedelic-Induced Changes in Social Functioning and Connectedness in a Naturalistic Online Sample Using the Five-Factor Model of Personality

The present study examines prospective changes in personality traits relevant to social functioning as well as perceived social connectedness in relation to the naturalistic use of psychedelic compounds in an online volunteer sample. The study also examined the degree to which demographic characteristics, social setting, baseline personality, and acute subjective factors (e.g., emotional breakthrough experiences) influenced trajectories of personality and perceived social connectedness. Participants recruited online completed self-report measures of personality and social connectedness at three timepoints (baseline, 2weeks post-experience, 4weeks post-experience). Linear mixed models were used to examine changes in outcomes and the moderation of these outcomes by covariates. The most substantive changes were reductions in the personality domains Neuroticism, and increases in Agreeableness and social connectedness. Notably, reductions in Neuroticism and increases in Agreeableness covaried over time, which may be suggestive of common processes involving emotion regulation. Preliminary evidence was found for a specific effect on a component of Agreeableness involving a critical and quarrelsome interpersonal style. Although moderation by demographic characteristics, social setting, baseline personality, and acute factors generally found limited support, baseline standing on Neuroticism, perspective taking, and social connectedness showed tentative signs of amplifying adaptive effects on each trait, respectively. Our findings hold implications for the potential use of psychedelics for treating interpersonal elements of personality pathology as well as loneliness.

Association between ACTH stimulation test results and clinical signs in dogs with hyperadrenocorticism treated with trilostane

Trilostane is the recommended medical treatment for dogs with hyperadrenocorticicm (HAC). The objective of this study was to investigate the association between ACTH stimulation test (ACTHST) results, and relevant clinical signs, in dogs treated with trilostane. A disease-specific questionnaire was developed, which included the owner's assessment of polydipsia, polyuria, polyphagia, panting, and satisfaction with the treatment, based on a 5-response category rating scale. Forty-nine dogs with HAC were prospectively enrolled. Dogs were grouped according to their recheck appointment (first recheck, 710 days after commencement of treatment or change of trilostane dose; second recheck, 4 weeks after the first recheck; third recheck, performed at 3-6 months intervals once the dog was well controlled). At the recheck appointment, the owner's questionnaire responses were recorded, and an ACTHST was performed, along with urine specific gravity measurement. Linear mixed effects models were used to assess differences among the three recheck time points and to test possible associations between ACTHST results and clinical signs. Significant differences between rechecks were present for stimulated cortisol (first to third recheck, P < 0.001; second to third recheck, P < 0.01), polydipsia (first to second recheck, P = 0.001), polyuria (first to second recheck, P < 0.001; first to third recheck, P = 0.001), and owner satisfaction (first to second recheck, P < 0.001; first to third recheck, P < 0.001). Backward stepwise variable elimination did not identify any significant associations between ACTHST results and clinical signs. Therefore, clinical signs of HAC were not predicted based on the ACTHST results.

Investigating the neural substrates of Antagonistic Externalizing and social-cognitive Theory of Mind: an fMRI examination of functional activity and synchrony

Recently developed quantitative models of psychopathology (i.e., Hierarchical Taxonomy of Psychopathology) identify an Antagonistic Externalizing spectrum that captures the psychological disposition toward criminal and antisocial behavior. The purpose of the present study was to examine relations between Antagonistic psychopathology (and associated Five-Factor model Antagonism/Agreeableness) and neural functioning related to social-cognitive Theory of Mind using a large sample (N = 973) collected as part of the Human Connectome Project (Van Essen et al., 2013a). No meaningful relations between Antagonism/Antagonistic Externalizing and Theory of Mind-related neural activity or synchrony were observed (p < .005). We conclude by outlining methodological considerations (e.g., validity of social cognition task and low test-retest reliability of functional biomarkers) that may account for these null results, and present recommendations for future research.

Evaluating the Instantiation of Narcissism Components in Contemporary Measures of Psychopathy

Narcissistic traits figure prominently in classical conceptualizations of psychopathy and bear substantial empirical overlap with components of psychopathy. Yet the degree to which various widely used self-report measures of psychopathy include relevant narcissistic content has not been evaluated, especially in relation to new, multidimensional models of narcissism. Using a large undergraduate sample (N = 432) and self- and informant-ratings of narcissism, the present study examined narcissism's instantiation in several commonly used self-report psychopathy measures. A modern conceptualization of narcissism at three levels of hierarchical organization (i.e., Trifurcated Model of Narcissism) was applied to comprehensively evaluate narcissism's instantiation in these psychopathy measures. Although narcissistic traits related to self-centered antagonism were well-instantiated across psychopathy self-report measures, narcissistic traits related to agentic extraversion were represented more modestly by most (i.e., Triarchic Psychopathy Measure, Self-Report Psychopathy Scale: Version III, Levenson Self-Report Psychopathy Scale), but not all (i.e., Elemental Psychopathy Assessment [EPA]) psychopathy measures. Only the EPA contained substantial representation of all narcissism components. Given the theoretical and empirical overlap between psychopathy and narcissism, it behooves researchers to be aware of the degree to which psychopathy measures capture narcissistic content.

Examining the Contribution of Perfectionistic Traits to the Construct Validity of the DSM-5 Alternative Model of Personality Disorder

Scholars of perfectionism have proposed significant modifications to DSM-5's alternative model of personality disorders (AMPD), such that (1) perfectionism be expanded beyond the inclusion of a singular trait-rigid perfectionism-and (2) perfectionistic traits be specified as trait descriptors of personality disorders (PDs) other than obsessive-compulsive PD. In this study, we evaluate these proposals by examining the degree to which (a) perfectionistic traits are already instantiated in Section II and Section III models of personality pathology; and (b) perfectionistic traits meaningfully augment the construct validity of AMPD PDs. We conducted these approaches in a large sample (N =3D 435) from an Iranian undergraduate population that is atypically found in the literature. Results showed that perfectionistic traits are already fairly well instantiated in Section III Criterion B. Perfectionistic traits minimally improved the construct validity of OCPD, but did not meaningfully do so for other PDs. Future investigation into the clinical utility of perfectionistic traits is needed.

Clinical Correlates of Vulnerable and Grandiose Narcissism: A Personality Perspective

There is broad consensus that there are at least two different dimensions of narcissism: vulnerable and grandiose. In this study, the authors use a new trifurcated, three-factor model of narcissism to examine relations between aspects of narcissism and an array of clinically relevant criteria related to psychopathology, the self, authenticity, and well-being. Neurotic and antagonistic aspects of narcissism emerged as the most clinically relevant dimensions of narcissism, bearing relations with outcomes relating to interpersonal guilt, insecure attachment styles, cognitive distortions, maladaptive defense mechanisms, experiential avoidance, impostor syndrome, weak sense of self, inauthenticity, low self-esteem, and reduced psychological well-being. Grandiose narcissism was not correlated with most forms of psychopathology and was even positively associated with life satisfaction. Nevertheless, a surprising link was found between grandiose narcissism and multiple indicators of inauthenticity. Implications for the appropriate conceptualization, assessment, and treatment of pathological narcissism are discussed.

The DSM-5 section III personality disorder criterion a in relation to both pathological and general personality traits

Following the introduction of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), section III alternative model of personality disorder, much of the empirical attention has been directed toward testing the performance of Criterion B (i.e., pathological traits). Much more recently, with the development of assessment tools related to Criterion A (i.e., personality impairment), a burgeoning literature base is forming for it as well. A closer look at the Criterion A component, however, reveals disagreements around its structure, discriminant validity, ability to distinguish between personality-based and nonpersonality-based forms of psychopathology, overlap between the two criteria, and incremental validity. The goal of the current study (N = 365 undergraduates) was to test Criterion A in relation to both pathological personality traits, as specified in the DSM-5, and general personality traits, as some scholars suggested that might be more appropriate. The results suggest that impairment domains overlap substantially with pathological and general traits, and these traits account for considerable variance in impairment domains. Most importantly, the findings suggest that general and pathological traits functioned in nearly identical ways, as evidenced by the similar relations that they evinced with traditional DSM-5 personality disorder constructs. In line with previous work, the present findings demonstrate limited discriminant validity among impairment domains and an inability to distinguish between Axis I and II symptoms. Further research on the alternative model of personality disorder is needed to test the necessity and sufficiency of its constituent components. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Examining hypothesized interactive and curvilinear relations between psychopathic traits and externalizing problems in an offender sample using item response-based analysis

Fearless dominance (FD) generally manifests null to small relations with externalizing problems, leading some researchers to propose alternative paths by which FD features may relate to these problems. The current study provides a test of two possibilities, namely that FD (a) interacts statistically with self-centered impulsivity (SCI) such that FD is associated with externalizing problems only at high levels of SCI and (b) demonstrates curvilinear relations with externalizing problems such that FD is more strongly associated with these problems at high levels. We used a large correctional sample and item-response theory-related statistics to precisely estimate individuals' scores at the extremes of each major psychopathic trait. FD was not significantly associated with externalizing problems in interaction with SCI or at higher levels of FD, suggesting that psychopathic traits linked to boldness are not especially relevant to generalized externalizing behavior. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Percutaneous Interventional Management of Spinal Metastasis

Spinal metastasis is usually associated with debilitating pain and results in deteriorating life quality. The role of percutaneous management of spinal metastasis has evolved from a diagnostic role to a significant part of therapeutic options in conjunction with conventional management techniques, including radiotherapy and open surgical options. Percutaneous vertebral augmentation (PVA) showed substantial pain reduction, vertebral stabilization, and improvement of quality of life. Minimally invasive local ablative procedures (MILAPs) demonstrated significant pain reduction, local tumor burden control, and improvement of quality of life. Though combined PVA and MILAP's synergistic role in pain reduction may need additional investigation, considering different actions on spine metastasis patients, combining both techniques might beneficial to selected patients. The role of percutaneous management will likely expand since its role in improving patient's quality of life with very minimal procedure-related risk and in conjunction with future technological advancement.

Altered T cell receptor beta repertoire patterns in pediatric ulcerative colitis

The antigenic specificity of T cells occurs via generation and rearrangement of different gene segments producing a functional T cell receptor (TCR). High-throughput sequencing (HTS) allows in-depth assessment of TCR repertoire patterns. There are limited data concerning whether TCR repertoires are altered in inflammatory bowel disease. We hypothesized that pediatric ulcerative colitis (UC) patients possess unique TCR repertoires, resulting from clonotypical expansions in the gut. Paired blood and rectal samples were collected from nine newly diagnosed treatment-naive pediatric UC patients and four healthy controls. DNA was isolated to determine the TCR-β repertoire by HTS. Significant clonal expansion was demonstrated in UC patients, with inverse correlation between clinical disease severity and repertoire diversity in the gut. Using different repertoire variables in rectal biopsies, a clear segregation was observed between patients with severe UC, those with mild-moderate disease and healthy controls. Moreover, the overlap between autologous blood-rectal samples in UC patients was significantly higher compared with overlap among controls. Finally, we identified several clonotypes that were shared in either all or the majority of UC patients in the colon. Clonal expansion of TCR-β-expressing T cells among UC patients correlates with disease severity and highlights their involvement in mediating intestinal inflammation.

Personality change among newlyweds: Patterns, predictors, and associations with marital satisfaction over time

The early years of marriage are a time of significant personal and relational changes as partners adjust to their new roles, but the specific ways that spouses' personalities may change in early marriage and how these changes are associated with spouses' marital satisfaction trajectories have been overlooked. Using 3 waves of data collected over the first 18 months of marriage (N = 338 spouses, or 169 heterosexual newlywed marriages), we examined changes in spouses' self-reported Big 5 personality traits over time and the association between initial levels and changes in personality and spouses' concurrent marital satisfaction trajectories. Results indicated significant changes in personality over time, including declines in agreeableness for husbands and for wives, declines in extraversion for husbands, declines in openness and neuroticism for wives, and increases in conscientiousness for husbands. These results did not differ by spouses' age, demographics, relationship length prior to marriage, cohabitation prior to marriage, initial marital satisfaction, or parenthood status. Initial levels of personality as well as changes in personality over time were associated with spouses' marital satisfaction trajectories. Taken together, these findings indicate that newlywed spouses' personalities undergo meaningful changes during the newlywed years and these changes are associated with changes in spouses' marital satisfaction. Further research is needed to understand the processes underlying changes in personality early in marriage and to examine the mechanisms linking changes in personality and changes in marital satisfaction. (PsycINFO Database Record

Neuroplasticity following short-term strength training occurs at supraspinal level and is specific for the trained task

AIMS

Different modalities of strength training cause performance enhancements, which are specific for the trained task. However, the involved mechanisms are still largely unknown. It has been demonstrated that strength training could induce neuroplasticity, which might underlie the performance improvements during the first training sessions. Thus, we hypothesized to find task-specific neuroplasticity after a short-term strength training of two distinct strength tasks.

METHODS

Young healthy male subjects were exposed to 4 sessions of either maximal isometric explosive (EXPL group, N = 9) or slow sustained (SUS group, N = 10) knee extensions. Pre- and post-training, we measured H-reflexes and motor evoked potentials (MEPs) in the vastus lateralis (VL) at the onset of both strength tasks.

RESULTS

Pre- and post-training, H-reflexes remained unchanged in both groups. MEP areas were lower in the trained task in both groups and remained unchanged in the untrained task.

CONCLUSION

This study demonstrated that short-term strength training induces specific neuroplasticity for the trained task only. The fact that MEPs were lower but H-reflex amplitudes remained unchanged at the onset of the trained tasks suggests that strength training elicited neuroplasticity at supraspinal level that most likely reflect an improved task-specific corticospinal efficiency.

Self- and partner-reported psychopathic traits' relations with couples' communication, marital satisfaction trajectories, and divorce in a longitudinal sample

Given that psychopathy is composed in large part by an antagonistic relational approach and is associated with many troubling interpersonally relevant outcomes, its role in romantic functioning warrants greater attention. The current study used data from a community sample of 172 newlywed couples to examine spouses' psychopathic traits in relation to their partners' psychopathic traits, observed communication, 4-year marital satisfaction trajectories, and 10-year divorce rates. Spouses reporting greater levels of psychopathic traits were married to partners reporting greater levels of psychopathic traits. Psychopathic traits were correlated cross-sectionally with more negative affect and less positive affect during conversations regarding sources of tension in the relationship. Longitudinally, hierarchical linear modeling of spouses' 4-year marital trajectories indicated that psychopathic traits generally predicted lower initial and sustained marital satisfaction for spouses and their partners over time. In addition, wives' ratings of husbands' psychopathic traits predicted declines in husbands' satisfaction over time and elevated 10-year divorce rates. These findings highlight the relationship impairment associated with psychopathic traits, indicate that this impairment is present from the beginning of couples' marital trajectories, and show that psychopathic traits predict divorce. Findings also suggest that partner-ratings of psychopathic traits provide substantial incremental validity in the prediction of marital functioning outcomes relative to self-ratings. Future research on the pathways by which psychopathic traits undermine relationship functioning over time would be valuable. (PsycINFO Database Record

Caseness rates and risk factors for depression among Vietnamese cancer patients

OBJECTIVE

Research suggests that rates of depression among general population samples in Asia may be significantly lower than in much of the rest of the world. However, whether this applies to depression among cancer patients is unclear, which is important to determine in order to identify depression treatment needs among cancer patients in this region. The purpose of the present study was to assess caseness rates of serious depression among general cancer patients in the Southeast Asian nation of Viet Nam.

METHOD

A total of 695 adult cancer patients from three hospitals in Da Nang, Viet Nam served as study participants. They were assessed at one time point for (a) demographic and (b) cancer characteristics, and (c) depression symptoms.

RESULTS

The overall caseness rate for serious depression was 28%. Although rates of depression in general population samples usually are significantly higher in women than men, rates of depression among men and women did not differ significantly among our cancer patients. Higher levels of depressive symptoms were found, however, as a function of lower patient income and education, occupation, cancer stage, and type of cancer, but not marital status or age.

CONCLUSIONS

Caseness rates of depression are significantly elevated by a factor of 10-15 among Vietnamese cancer patients relative to general population epidemiological studies in the same region. Although a number of studies have found that rates of depression tend to be lower in Asian as compared to Western general population samples, depression rates among our Vietnamese cancer patients were similar to those reported among Western cancer patients. This suggests that whatever factors are responsible for the relatively low rates of depression observed in Asian general population samples may not be operating in regards to cancer-related depression. Overall, the value of these findings are not only that they provide information for policy makers in Viet Nam to support depression treatment among cancer patients, but also that they suggest that despite the apparent relatively low overall rates of depression it may be useful for cancer and mental health researchers in the region to conduct similar assessments for their policy makers.

Effects of the family schizophrenia psychoeducation program for individuals with recent onset schizophrenia in Viet Nam

OBJECTIVE

Although psychoeducation has been found effective for improving the life functioning of patients with schizophrenia in high income countries, there have been relatively few studies of schizophrenia psychoeducation adapted for low and middle-income countries (LMIC), particularly in Southeast Asia. The present study assessed effects of the Family Schizophrenia Psychoeducation Program (FSPP) among Vietnamese patients and their families on the patients' (1) quality of life and (2) medication non-compliance, and the family and patients' (3) stigma towards schizophrenia, and (4) consumer satisfaction.

METHOD

This intervention study involved 59 patients, and their families, from the Da Nang Psychiatric Hospital, randomly assigned to treatment (n=30) or control (n=29) conditions. Control subjects received services as usual (antipsychotic medication); treatment group subjects received the FSPP as well. Blind-rater assessments were conducted at T1 immediately after project enrollment (prior to participating in the FSPP) and at T2 six months later.

RESULTS

There were significant treatment effects on: (1) quality of life, (2) stigma, (3) medication compliance, and (4) consumer satisfaction, with all effects favoring the treatment group. Effect sizes were moderate to large.

CONCLUSIONS

This psychoeducation program appears to reduce stigma, improve quality of life and medication compliance, and increase consumer satisfaction of Vietnamese patients with schizophrenia and their families, beyond the effects of antipsychotic medication. It involves relatively little cost, and it may be useful for it or equivalent programs to be implemented in other hospitals in Viet Nam, and potentially other low-income Asian countries to improve the lives of patients with schizophrenia.

High-Intensity Focused Ultrasound (HIFU) for Specific Therapeutic Treatments: A Literature Review

A literature review is provided concerning the scientific studies that have been published involving high-intensity focused ultrasound (HIFU) as a therapeutic treatment for tumors of the prostate, uterus, and brain. This is a revival of earlier work that now focuses on targeted therapy with sonography, but the studies that have been conducted vary in their level of evidence and translation to clinical practice. The review arranges the published studies by levels of evidence and provides a meta-analysis of the potential for using HIFU to treat prostate cancer, fibroids, and glioblastomas. Human studies are needed that provide clear levels of frequency, intensity, temperature, and treatment patterns. The bioeffects of sonography play a huge role in the destruction of these tumors as well as the potential to cause collateral damage in the surrounding healthy tissue. The hope is that with continued research, a fusion of technology with HIFU can provide patients with a noninvasive, nonionizing therapy for these lesions.

Operative Outcomes with Myxomatous Mitral Valve Repair: Experience with 586 Patients

INTRODUCTION

American Heart Association (AHA) guidelines recommend mitral valve repair for myxomatous mitral regurgitation whenever possible to prevent LV dysfunction and early mortality. Here we review our early operative outcomes with mitral valve repair for myxomatous mitral regurgitation.

METHODS

We collected data from 586 consecutive patients that underwent mitral repair for myxomatous disease at the Prince Henry and Prince of Wales Hospitals Sydney between 1997 and 2012. All patients had pre- and postoperative transthoracic echocardiograms.

RESULTS

In the first 30 days postoperatively there were five deaths (0.9%), four strokes (0.7%) and five transient ischaemic attacks (TIAs) (0.9%). Repair involved resection in 55.5%, neochordal reconstruction in 41.6%, and in 2.9% a combination of both. There was increasing use of neochordae since 2006. At discharge 99% had mitral regurgitation (MR) ≤ mild and ≤ trivial in 79.5%. For posterior leaflet disease neochordae had improved MR at discharge compared with resection (85% vs 78%, P<0.05). Preoperative triscupid regurgitation (TR) and pulmonary hypertension > mild were associated with a greater degree of MR at discharge (P<0.05) for reasons that are unclear.

CONCLUSION

We have shown excellent early results for mitral repair with very low operative mortality and excellent freedom from significant MR. Successful mitral repairs with low morbidity have resulted in a pattern of early referral in keeping with the current guidelines.

Patient characteristics as a moderator of post-traumatic stress disorder treatment outcome: combining symptom burden and strengths

BACKGROUND

Post-traumatic stress disorder (PTSD) psychotherapy research has failed to identify patient characteristics that consistently predict differential outcome.

AIMS

To identify patient characteristics associated with differential outcome via a statistically generated composite moderator among women with childhood abuse-related PTSD in a randomised controlled trial comparing exposure therapy, skills training and their combination.

METHOD

Six baseline patient characteristics were combined in a composite moderator of treatment effects for PTSD symptoms across the three treatment conditions through a 6-month follow-up.

RESULTS

The optimal moderator was the combined burden of all symptoms and emotion regulation strength. Those with high moderator scores, reflecting high symptom load relative to emotion regulation, did least well in exposure, moderately well in skills and best in the combination.

CONCLUSIONS

A clinically meaningful moderator, which combines patient symptom burden and strengths, was identified. Assessment at follow-up may provide a more accurate indicator of variability in outcome than that obtained immediately post-treatment.

DECLARATION OF INTEREST

None.

COPYRIGHT AND USAGE

© The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

SmartSenior@home: Acceptance of an integrated ambient assisted living system. Results of a clinical field trial in 35 households

AIMS

The primary objective of the SmartSenior@home study was to examine the acceptance of the SmartSenior system by older adults.

METHODS

Twenty-eight partners from industry and research, including the health care sector, worked collaboratively to implement services aiming to maximize independence in old age. The prospective cohort study was conducted in Potsdam, Germany, with n = 35 older adults between 55 and 88 years of age in their apartments. All participants underwent extensive pre- and post-study visits with in-home interviews, functional assessments for cognition, fine motor skills, and mobility as well as responding to questionnaires on user acceptance and quality of life.

RESULTS

The results indicate moderate-to-high user acceptance for the SmartSenior system. In particular, the services for general assistance and health, such as audio/video communication, blood pressure monitoring, and communication with a health professional, were rated as very attractive. Less used and less accepted services were those promoting social interaction and reminder services.

CONCLUSION

Besides reliable functioning of the SmartSenior system, the availability of a confidant seems to be the most significant acceptance factor. As one conclusion of this trial, it is possible to develop, integrate, and test an infrastructure for ambient assisted living services in real life.

Identification and functional characterization of rare SHANK2 variants in schizophrenia

Recent genetic data on schizophrenia (SCZ) have suggested that proteins of the postsynaptic density of excitatory synapses have a role in its etiology. Mutations in the three SHANK genes encoding for postsynaptic scaffolding proteins have been shown to represent risk factors for autism spectrum disorders and other neurodevelopmental disorders. To address if SHANK2 variants are associated with SCZ, we sequenced SHANK2 in 481 patients and 659 unaffected individuals. We identified a significant increase in the number of rare (minor allele frequency<1%) SHANK2 missense variants in SCZ individuals (6.9%) compared with controls (3.9%, P=0.039). Four out of fifteen non-synonymous variants identified in the SCZ cohort (S610Y, R958S, P1119T and A1731S) were selected for functional analysis. Overexpression and knockdown-rescue experiments were carried out in cultured primary hippocampal neurons with a major focus on the analysis of morphological changes. Furthermore, the effect on actin polymerization in fibroblast cell lines was investigated. All four variants revealed functional impairment to various degrees, as a consequence of alterations in spine volume and clustering at synapses and an overall loss of presynaptic contacts. The A1731S variant was identified in four unrelated SCZ patients (0.83%) but not in any of the sequenced controls and public databases (P=4.6 × 10(-5)). Patients with the A1731S variant share an early prodromal phase with an insidious onset of psychiatric symptoms. A1731S overexpression strongly decreased the SHANK2-Bassoon-positive synapse number and diminished the F/G-actin ratio. Our results strongly suggest a causative role of rare SHANK2 variants in SCZ and underline the contribution of SHANK2 gene mutations in a variety of neuropsychiatric disorders.