Case-series Evaluating a Transdiagnostic Cognitive-behavioral Treatment For Co-occurring Anxiety Disorders.

Background. Patients with anxiety disorder diagnoses commonly have more than one anxiety diagnosis. While cognitive-behavioral interventions have proven efficacy in treating single anxiety disorder diagnoses, there has been little investigation of their efficacy in treating cooccurring anxiety disorders. Aims. To evaluate the efficacy of a transdiagnostic cognitive-behavioral intervention for treating co-occurring anxiety disorders. Methods. An A-B single case study design (N = 6) was used to evaluate the efficacy of a 12 to 13 session modular transdiagnostic cognitive-behavioral intervention for treating co-occurring anxiety disorders across patients with at least two of the following diagnoses: GAD, Social Phobia, Panic Disorder and/or OCD. Results. Five of the six participants completed treatment. At post-treatment assessment the five treatment completers achieved diagnostic and symptomatic change with three participants being diagnosis free. All participants who completed treatment no longer met criteria for any DSM-IV-TR Axis-I diagnosis at the three-month follow-up assessment, and demonstrated reliable and clinically-significant improvements in symptoms. Across the participants, statistically significant improvements from pre- to post-intervention were found on measures of anxiety, depression and general well-being, and all improvements were maintained at three-month follow-up. Conclusions. Results suggest that transdiagnostic cognitive behavioral interventions can be of benefit to patients with co-occurring anxiety disorders.

Adverse Childhood Life Events and Postpartum Psychosis in Bipolar Disorder

Background Women with bipolar disorder are at increased risk of postpartum psychosis. Adverse childhood life events have been associated with depression in the postpartum period, but have been little studied in relation to postpartum psychosis. In this study we investigated whether adverse childhood life events are associated with postpartum psychosis in a large sample of women with bipolar I disorder. Methods Participants were 432 parous women with DSM-IV bipolar I disorder recruited into the Bipolar Disorder Research Network (www.BDRN.org). Diagnoses and lifetime psychopathology, including perinatal episodes, were obtained via a semi-structured interview (Schedules for Clinical Assessment in Neuropsychiatry; Wing et al., 1990) and case-notes. Adverse childhood life events were assessed via self-report and case-notes, and compared between women with postpartum psychosis (n=208) and those without a lifetime history of perinatal mood episodes (n=224). Results There was no significant difference in the rate of any adverse childhood life event, including childhood sexual abuse, or in the total number of adverse childhood life events between women who experienced postpartum psychosis and those without a lifetime history of perinatal mood episodes, even after controlling for demographic and clinical differences between the groups. Limitations Adverse childhood life events were assessed in adulthood and therefore may be subject to recall errors. Conclusions We found no evidence for an association between adverse childhood life events and the occurrence of postpartum psychosis. Our data suggest that, unlike postpartum depression, childhood adversity does not play a significant role in the triggering of postpartum psychosis in women with bipolar disorder.

Diagnostic Tests and their Application in the Management of Soil- and Water-borne Oomycete Pathogen Species

Oomycete diseases cause significant losses across a broad range of crop and aquaculture commodities worldwide. These losses can be greatly reduced by disease management practices steered by accurate and early diagnoses of pathogen presence. Determinations of disease potential can help guide optimal crop rotation regimes, varietal selections, targeted control measures, harvest timings and crop post-harvest handling. Pathogen detection prior to infection can also reduce the incidence of disease epidemics. Classical methods for the isolation of oomycete pathogens are normally deployed only after disease symptom appearance. These processes are often-time consuming, relying on culturing the putative pathogen(s) and the availability of expert taxonomic skills for accurate identification; a situation that frequently results in either delayed application, or routine ‘blanket’ over-application of control measures. Increasing concerns about pesticides in the environment and the food chain, removal or restriction of their usage combined with rising costs have focussed interest in the development and improvement of disease management systems. To be effective, these require timely, accurate and preferably quantitatve diagnoses. A wide range of rapid diagnostic tools, from point of care immunodiagnostic kits to next generation nucleotide sequencing have potential application in oomycete disease management. Here we review currently-available as well as promising new technologies in the context of commercial agricultural production systems, considering the impacts of specific biotic and abiotic and other important factors such as speed and ease of access to information and cost effectiveness

An Interdisciplinary Approach to the Management of Vocal Cord Dysfunction in an Elite Female Swimmer: a Case Study

Acute pulmonary disorders are commonplace within the athletic population, with exercise induced bronchoconstriction (EIB), and vocal cord dysfunction (VCD) common diagnoses. VCD is a condition that causes the adduction of the vocal folds during inhalation, causing obstruction at the larynx and thereby a severely impaired sporting performance. VCD can be brought on by laryngeal irritants, emotional and psychological stress and asthma. The gold standard of treatment for VCD centres on an interdisciplinary approach from specialists that often include a respiratory consultant, speech and language therapist (SLT) and a psychologist. The present case study details the interdisciplinary approach to the treatment of an elite female swimmer with VCD with an intervention programme that lasted nine weeks, instigated by a local general practitioner (G.P.) who chose to engage a Sport Psychology Consultant (SPC) due to the sport-specific nature of the psychological stress experienced by the individual. The steps involved in the design of the sport psychology interventions are outlined and the relationship of those interventions to the work of the other specialists is discussed. The 9 week intervention programme was aimed at reducing perfectionist tendencies and competitive state anxiety using a combination of cognitive behavioural therapy (CBT), goal-setting and imagery. Overall, the treatment programme was deemed a success as perfectionism and competitive state anxiety levels reduced over time along with the frequency of VCD occurrence. This case study demonstrates the breadth of roles that can be undertaken by a SPC and raises awareness of a complex respiratory disorder that is not yet fully understood.

Validation of Electronic Health Record Phenotyping of Bipolar Disorder Cases and Controls

Objective: The study was designed to validate use of elec-tronic health records (EHRs) for diagnosing bipolar disorder and classifying control subjects. Method: EHR data were obtained from a health care system of more than 4.6 million patients spanning more than 20 years. Experienced clinicians reviewed charts to identify text features and coded data consistent or inconsistent with a diagnosis of bipolar disorder. Natural language processing was used to train a diagnostic algorithm with 95% specificity for classifying bipolar disorder. Filtered coded data were used to derive three additional classification rules for case subjects and one for control subjects. The positive predictive value (PPV) of EHR-based bipolar disorder and subphenotype di- agnoses was calculated against diagnoses from direct semi- structured interviews of 190 patients by trained clinicians blind to EHR diagnosis. Results: The PPV of bipolar disorder defined by natural language processing was 0.85. Coded classification based on strict filtering achieved a value of 0.79, but classifications based on less stringent criteria performed less well. No EHR- classified control subject received a diagnosis of bipolar dis- order on the basis of direct interview (PPV=1.0). For most subphenotypes, values exceeded 0.80. The EHR-based clas- sifications were used to accrue 4,500 bipolar disorder cases and 5,000 controls for genetic analyses. Conclusions: Semiautomated mining of EHRs can be used to ascertain bipolar disorder patients and control subjects with high specificity and predictive value compared with diagnostic interviews. EHRs provide a powerful resource for high-throughput phenotyping for genetic and clinical research.