Pilot CBT trial for anxiety in alcohol use disorders treatment

Purpose – The purpose of this paper is to test the effectiveness of a self-directed cognitive behavioural therapy (CBT) booklet allowing immediate access to treatment for anxiety during alcohol use disorder (AUD) interventions. Design/methodology/approach – Parallel pilot randomised controlled trial: 69 individuals in AUD treatment, continued to receive treatment alone (control: n=29) or in addition, a self-directed, four week CBT booklet to manage anxiety (intervention: n=40). Primary outcome measures were changes in state (SAnx) and trait anxiety (TAnx) at four weeks. Secondary outcome measures were changes in adaptive (ACop), maladaptive (MCop) coping and quality of life (QoL, physical (PHQoL), psychological (PSQoL), social (SQoL), environment (EQoL)) at four weeks. Findings – Participants had significantly higher SAnx (p<0.01) and TAnx (p<0.01) baseline scores compared to the general population. There were no statistically significant group changes in SAnx or TAnx (p>0.05). Control group allocation predicted improvement in ACop (p<0.01), MCop (p<0.05), PHQoL (p<0.01), PSQoL (p<0.05) and SQoL (p<0.01); CBT group allocation predicted improvement in EQoL (p=0.05). All effect sizes were small to moderate (Cohen’s d<0.50). Percentage of book completion did not determine changes in anxiety, coping or quality of life. Originality/value – A four week self-directed CBT booklet did not significantly reduce anxiety during AUD treatment. Larger sample sizes will determine the most suitable treatment delivery mode for this type of CBT.

A comparison of the 27-item and 12-item intolerance of uncertainty scales

The 27-item Intolerance of Uncertainty Scale (IUS) has become one of the most frequently used measure of Intolerance of Uncertainty. More recently, an abridged, 12-item version of the IUS has been developed. The current research used clinical (n = 50) and non-clinical (n = 56) samples to examine and compare the psychometric properties of both versions of the IUS. The two scales showed good internal consistency at both the total and subscale level and had satisfactory test-retest reliability. Both versions were correlated with worry and trait anxiety and had satisfactory concurrent validity. Significant differences between the scores of the clinical and non-clinical sample supported discriminant validity. Predictive validity was also supported for the two scales. Total scores, in the case of the clinical sample, and a subscale, in the case of the non-clinical sample, significantly predicted pathological worry and trait anxiety. Overall, the clinicians and researchers can use either version of the IUS with confidence, due to their sound psychometric properties.

Risk factors for malnutrition in community-dwelling people with Parkinson’s disease

In the elderly, the risks for protein-energy malnutrition from older age, dementia, depression and living alone have been well-documented. Other risk factors including anorexia, gastrointestinal dysfunction, loss of olfactory and taste senses and early satiety have also been suggested to contribute to poor nutritional status. In Parkinson’s disease (PD), it has been suggested that the disease symptoms may predispose people with PD to malnutrition. However, the risks for malnutrition in this population are not well-understood. The current study’s aim was to determine malnutrition risk factors in community-dwelling adults with PD. Nutritional status was assessed using the Patient-Generated Subjective Global Assessment (PG-SGA). Data about age, time since diagnosis, medications and living situation were collected. Levodopa equivalent doses (LDED) and LDED per kg body weight (mg/kg) were calculated. Depression and anxiety were measured using the Beck’s Depression Inventory (BDI) and Spielberger Trait Anxiety questionnaire, respectively. Cognitive function was assessed using the Addenbrooke’s Cognitive Examination (ACE-R). Non-motor symptoms were assessed using the Scales for Outcomes in Parkinson's disease-Autonomic (SCOPA-AUT) and Modified Constipation Assessment Scale (MCAS). A total of 125 community-dwelling people with PD were included, average age of 70.2±9.3(35-92) years and average time since diagnosis of 7.3±5.9(0–31) years. Average body mass index (BMI) was 26.0±5.5kg/m2. Of these, 15% (n=19) were malnourished (SGA-B). Multivariate logistic regression analysis revealed that older age (OR=1.16, CI=1.02-1.31), more depressive symptoms (OR=1.26, CI=1.07-1.48), lower levels of anxiety (OR=.90, CI=.82-.99), and higher LDED per kg body weight (OR=1.57, CI=1.14-2.15) significantly increased malnutrition risk. Cognitive function, living situation, number of prescription medications, LDED, years since diagnosis and the severity of non-motor symptoms did not significantly influence malnutrition risk. Malnutrition results in poorer health outcomes. Proactively addressing the risk factors can help prevent declines in nutritional status. In the current study, older people with PD with depression and greater amounts of levodopa per body weight were at increased malnutrition risk.

Markers of disease severity are associated with malnutrition in Parkinson's disease

Objective In Parkinson's disease (PD), commonly reported risk factors for malnutrition in other populations commonly occur. Few studies have explored which of these factors are of particular importance in malnutrition in PD. The aim was to identify the determinants of nutritional status in people with Parkinson's disease (PWP). Methods Community-dwelling PWP (>18 years) were recruited (n = 125; 73M/52F; Mdn 70 years). Self-report assessments included Beck's Depression Inventory (BDI), Spielberger Trait Anxiety Inventory (STAI), Scales for Outcomes in Parkinson's disease – Autonomic (SCOPA-AUT), Modified Constipation Assessment Scale (MCAS) and Freezing of Gait Questionnaire (FOG-Q). Information about age, PD duration, medications, co-morbid conditions and living situation was obtained. Addenbrooke's Cognitive Examination (ACE-R), Unified Parkinson's Disease Rating Scale (UPDRS) II and UPDRS III were performed. Nutritional status was assessed using the Subjective Global Assessment (SGA) as part of the scored Patient-Generated Subjective Global Assessment (PG-SGA). Results Nineteen (15%) were malnourished (SGA-B). Median PG-SGA score was 3. More of the malnourished were elderly (84% vs. 71%) and had more severe disease (H&Y: 21% vs. 5%). UPDRS II and UPDRS III scores and levodopa equivalent daily dose (LEDD)/body weight(mg/kg) were significantly higher in the malnourished (Mdn 18 vs. 15; 20 vs. 15; 10.1 vs. 7.6 respectively). Regression analyses revealed older age at diagnosis, higher LEDD/body weight (mg/kg), greater UPDRS III score, lower STAI score and higher BDI score as significant predictors of malnutrition (SGA-B). Living alone and higher BDI and UPDRS III scores were significant predictors of a higher log-adjusted PG-SGA score. Conclusions In this sample of PWP, the rate of malnutrition was higher than that previously reported in the general community. Nutrition screening should occur regularly in those with more severe disease and depression. Community support should be provided to PWP living alone. Dopaminergic medication should be reviewed with body weight changes.

Defining the parental burden of acute cough in children

Despite the prevalence of acute cough in children (<2 weeks duration), the burden to parents and families is largely unknown. The objectives of this study were to determine the parental burden of children’s acute cough, and to evaluate psychological and other infl uences on the reported burden of acute cough in children. Methods Parents of children with a current acute cough (<2 weeks) at enrolment completed 4 questionnaires (state trait anxiety inventory (STAI); short form health survey (SF-8); depression, anxiety and stress 21-item scale (DASS21); and our preliminary 48-item parent acute cough specifi c quality of life (PAC-QOL48) questionnaire). In PAC-QOL48, lower scores refl ect worse QOL. Results Median age of the 104 children enrolled was 2.63 (IQR 1.42, 4.79) years, 54 were boys. Median length of cough at enrolment was 3 (IQR 2, 5) days. Median total PAC-QOL48 score of parents enrolled at presentation to the emergency department (n = 70) was signifi cantly worse than of parents enrolled through the community (n = 24) (p < 0.01). More than half (n = 55) had sought medical assistance more than once for the current acute coughing illness. PAC-QOL48 score was signifi cantly negatively correlated to verbal category descriptive and visual analogue scale cough scores (Spearman r = −0.26, p = 0.05 and r = −0.46, p = 0.01 respectively) and DASS21 total score (r = −0.36, p = 0.01), but not to child’s age. Conclusions Consistent with data on chronic cough, stress was the predominant factor of parental burden. This study highlights the ongoing need for clinicians to be cognizant of parental worries and concerns when their children are coughing, and for further research into safe and effective therapies for acute cough in children.

Psychological effects upon exposure to polyhalogenated dibenzodioxins and dibenzofurans

Thirty workers who had been exposed to combustion products for several years due to testing of flame retarding qualities of building materials and 30 controls from the same facility were investigated. Concentrations found in samples taken from different places of the facility were up to 14,660 μg/kg for polybrominated dibenzofurans and up to 67.1 μg/kg for polychlorinated dibenzodioxins (PCDDs) and dibenzofurans (PCDFs). Physical examination, routine laboratory parameters, and blood fat concentrations of PCDDs and PCDFs revealed normal findings. Neurotoxic symptoms showed a weak tendency of overrepresentation among the exposed workers. The frequency of neurobehavioural symptoms increased significantly with trait anxiety independent of exposure to combustion products. (C) 2000 Elsevier Science Ltd.

An acute cough-specific quality of life questionnaire for children: Development and validation

Background Patient-relevant outcome measures are essential for high-quality clinical research, and quality-of-life (QoL) tools are the current standard. Currently, there is no validated children's acute cough-specific QoL questionnaire. Objective The objective of this study was to develop and validate the Parent-proxy Children's Acute Cough-specific QoL Questionnaire (PAC-QoL). Methods Using focus groups, a 48-item PAC-QoL questionnaire was developed and later reduced to 16 items by using the clinical impact method. Parents of children with a current acute cough (<2 weeks) at enrollment completed 2 validated cough score measures, the preliminary 48-item PAC-QoL, and 3 other questionnaires (the State Trait Anxiety Inventory [STAI], the Short-Form 8-item 24-hour recall Health Survey [SF-8], and the Depression, Anxiety, and Stress 21-item Scale [DASS21]). All measures were repeated on days 3 and 14. Results The median age of the 155 children enrolled was 2.3 years (interquartile range, 1.3-4.6). Median cough duration at enrollment was 3 days (interquartile range, 2-5). The reduced 16-item scale had high internal consistency (Cronbach α = 0.95). Evidence for repeatability and criterion validity was shown by significant correlations between the domains and total PAC-QoL scores and the SF-8 (r = −0.36 and −0.51), STAI (r = −0.27 and −0.39), and DASS21 (r = −0.32 and −0.41) scales on days 0 and 3, respectively. The final PAC-QoL questionnaire was sensitive to change over time, with changes significantly relating to changes in cough score measures (P < .001). Conclusion The 16-item PAC-QoL is a reliable and valid outcome measure that assesses QoL related to childhood acute cough at a given time point and reflects changes in acute cough-specific QoL over time.

Psychosocial functioning in patients with alcohol-related liver disease post liver transplantation

Emotional and role functioning difficulties are associated with chronic alcohol use and liver disease. Little is known about prospective changes in psychological and psychosocial functioning following orthotopic liver transplantation (OLT) amongst patients with alcoholic liver disease (ALD). We aimed to assess the functioning of this patient group post liver transplantation. Comprehensive psychosocial assessment of depression (Beck Depression Inventory [BDI]), anxiety (State-Trait Anxiety Inventory-Form X [STAI]) and psychosocial adjustment (Psychosocial Adjustment to Illness Scale-Self-Report version [PAIS-SR]) was conducted with 42 ALD patients available for pre and post OLT testing. Dependence severity was assessed by the Brief Michigan Alcoholism Screening Test (bMAST). Significant reductions in average anxiety and depression symptoms were observed 12-months post-OLT. Significant improvements in psychosocial adjustment to illness were also reported. Patients with higher levels of alcohol dependence severity pre transplant assessment improved comparably to those with lower levels of dependence. In summary, the study found that OLT contributed to reducing overall levels of mood and anxiety symptoms in ALD patients, approximating general (non-clinical) population norms. Psychosocial adjustment also improved significantly post liver transplantation.

Pain in juvenile idiopathic arthritis : parents and children as agents of disease management

Juvenile idiopathic arthritis (JIA) is a severe childhood disease usually characterized by long-term morbidity, unpredictable course, pain, and limitations in daily activities and social participation. The disease affects not only the child but also the whole family. The family is expected to adhere to an often very laborious regimen over a long period of time. However, the parental role is incoherently conceptualized in the research field. Pain in JIA is of somatic origin, but psychosocial factors, such as mood and self-efficacy, are critical in the perception of pain and in its impact on functioning. This study examined the factors correlating and possibly explaining pain in JIA, with a special emphasis on the mutual relations between parent- and patient-driven variables. In this patient series pain was not associated with the disease activity. The degree of pain was on average fairly low in children with JIA. When the children were clustered according to age, anxiety and depression, four distinguishable cluster groups significantly associated with pain emerged. One of the groups was described by concept vulnerability because of unfavorable variable associations. Parental depressive and anxiety symptoms accompanied by illness management had a predictive power in discriminating groups of children with varying distress levels. The parent’s and child’s perception of a child’s functional capability, distress, and somatic self-efficacy had independent explanatory power predicting the child’s pain. Of special interest in the current study was self-efficacy, which refers to the belief of an individual that he/she has the ability to engage in the behavior required for tackling the disease. In children with JIA, strong self-efficacy was related to lower levels of pain, depressive symptoms and trait anxiety. This suggests strengthening a child’s sense of self-efficacy, when helping the child to cope with his or her disease. Pain experienced by a child with JIA needs to be viewed in a multidimensional bio-psycho-social context that covers biological, environmental and cognitive behavioral mechanisms. The relations between the parent-child variables are complex and affect pain both directly and indirectly. Developing pain-treatment modalities that recognize the family as a system is also warranted.

Developmental origins of psychological vulnerability factors for mental disorders

Premature birth and associated small body size are known to affect health over the life course. Moreover, compelling evidence suggests that birth size throughout its whole range of variation is inversely associated with risk for cardiovascular disease and type 2 diabetes in subsequent life. To explain these findings, the Developmental Origins of Health and Disease (DOHaD) model has been introduced. Within this framework, restricted physical growth is, to a large extent, considered either a product of harmful environmental influences, such as suboptimal nutrition and alterations in the foetal hormonal milieu, or an adaptive reaction to the environment. Whether inverse associations exist between body size at birth and psychological vulnerability factors for mental disorders is poorly known. Thus, the aim of this thesis was to study in three large prospective cohorts whether prenatal and postnatal physical growth, across the whole range of variation, is associated with subsequent temperament/personality traits and psychological symptoms that are considered vulnerability factors for mental disorders. Weight and length at birth in full term infants showed quadratic associations with the temperamental trait of harm avoidance (Study I). The highest scores were characteristic of the smallest individuals, followed by the heaviest/longest. Linear associations between birth size and psychological outcomes were found such that lower weight and thinness at birth predicted more pronounced trait anxiety in late adulthood (Study II); lower birth weight, placental size, and head circumference at 12 months predicted a more pronounced positive schitzotypal trait in women (Study III); and thinness and smaller head circumference at birth associated with symptoms of attention-deficit hyperactivity disorder (ADHD) in children who were born at term (Study IV). These associations occured across the whole variation in birth size and after adjusting for several confounders. With respect to growth after birth, individuals with high trait anxiety scores in late adulthood were lighter in weight and thinner in infancy, and gained weight more rapidly between 7 and 11 years of age, but weighed less and were shorter in late adulthood in relation to weight and height measured at 11 years of age (Study II). These results suggest that a suboptimal prenatal environment reflected in smaller birth size may affect a variety of psychological vulnerability factors for mental disorders, such as the temperamental trait of harm avoidance, trait anxiety, schizotypal traits, and symptoms of ADHD. The smaller the birth size across the whole range of variation, the more pronounced were these psychological vulnerability factors. Moreover, some of these outcomes, such as trait anxiety, were also predicted by patterns of growth after birth. The findings are concordant with the DOHaD model, and emphasise the importance of prenatal factors in the aetiology of not only mental disorders but also their psychological vulnerability factors.

Integrated treatment of first episode psychosis with online training (e-learning): study protocol for a randomised controlled trial

Background: The integrated treatment of first episode psychosis has been shown to improve functionality and negative symptoms in previous studies. In this paper, we describe a study of integrated treatment (individual psychoeducation complementary to pharmacotherapy) versus treatment as usual, comparing results at baseline with those at 6-month re-assessment (at the end of the study) for these patients, and online training of professionals to provide this complementary treatment, with the following objectives: 1) to compare the efficacy of individual psychoeducation as add-on treatment versus treatment as usual in improving psychotic and mood symptoms; 2) to compare adherence to medication, functioning, insight, social response, quality of life, and brain-derived neurotrophic factor, between both groups; and 3) to analyse the efficacy of online training of psychotherapists. Methods/design: This is a single-blind randomised clinical trial including patients with first episode psychosis from hospitals across Spain, randomly assigned to either a control group with pharmacotherapy and regular sessions with their psychiatrist (treatment as usual) or an intervention group with integrated care including treatment as usual plus a psychoeducational intervention (14 sessions). Training for professionals involved at each participating centre was provided by the coordinating centre (University Hospital of Alava) through video conferences. Patients are evaluated with an extensive battery of tests assessing clinical and sociodemographic characteristics (Positive and Negative Syndrome Scale, State-Trait Anxiety Inventory, Liebowitz Social Anxiety Scale, Hamilton Rating Scale for Depression, Scale to Assess Unawareness of Mental Disorders, Strauss and Carpenter Prognostic Scale, Global Assessment of Functioning Scale, Morisky Green Adherence Scale, Functioning Assessment Short Test, World Health Organization Quality of Life instrument WHOQOL-BREF (an abbreviated version of the WHOQOL-100), and EuroQoL questionnaire), and brain-derived neurotrophic factor levels are measured in peripheral blood at baseline and at 6 months. The statistical analysis, including bivariate analysis, linear and logistic regression models, will be performed using SPSS. Discussion: This is an innovative study that includes the assessment of an integrated intervention for patients with first episode psychosis provided by professionals who are trained online, potentially making it possible to offer the intervention to more patients.

中职生的成就动机与行为问题的关系

Achievement motive is human’s social motive. In some sense, one’s all-life achievements are decided by his/her achievement motive. By which we can conclude that achievement motive has close connection with individual emotional experience. People pursuing success experience more positive emotion and less negative one, and have good behavioral adaptability. This study aims at explore the relation between achievement motive and behavior problems in the secondary vocational education schools through questionaries (the achievement motivation scale, UCLA Loneliness Scale，State-Trait Anxiety Inventory，Center for Epidemiologic Studies depression Scale and middle school students'behavior questionnaire). There were 1005 students whose age ranged from 14to21 years completed the questionnaires. The main conclusions of this thesis are as follows: (1) Achievement motive of student in the secondary vocational education schools is significantly lower than that of students in the senior high school. (2) Students in the secondary vocational education schools show more obvious emotion and Externalizing behavior problems than those of the senior high schools. (3) Students’ motivation for pursuing success in the secondary vocational education schools has negative correlation with emotion and Externalizing behavior problem, while the motivation for avoiding failure has positive correlation with the emotion and Externalizing behavior problem. Achievement motivation has negative correlation with emotion and Externalizing behavior problem. (4) Students’ achievement motivation shows obvious gender difference in the secondary vocational education schools. The avoiding failure element shows upward trend with the grades increasing and the difference is obvious. While the students’ achievement motive in the secondary vocational education schools shows significantly downward trend with the grades increasing. Whether holding a post at school has influence on the students’ achievement motivation, and the difference is significant. (5) Students’ Externalizing behavior problem in the secondary vocational education schools shows obvious gender difference. Whether holding a post at school has influence on the students’ Externalizing behavior problem, and depression and loneliness, and the difference is significant. Key words: Students in the Secondary Vocational Education Schools, Achievement Motivation, Behavior Problem, Emotion Problem, Externalizing Behavior Problem (Note: In this study, the behavior problems include not only the externalizing behavior problems, but also emotion problems.)

情绪干扰下焦虑水平对执行抑制的影响机制——事件相关电位研究

Behavioral inhibition model suggests the generation of anxiety is related with over-inhibition. For knowing about anxiety better, we used event-related potential (ERP) technique to explore the underlying mechanism of executive inhibition under the emotional distracter in high and low trait-anxious groups. Firstly, we set up the Chinese affective picture system (CAPS) as the stimuli of subsequent experiments. Secondly, we screened the high and low trait-anxious participants using the State-Trait Anxiety Inventory. In the first ERP study, a modified oddball paradigm was used with the positive, neutral and negative pictures as novel stimuli and the potentials evoked by three types pictures were analyzed. In the second ERP study, the same paradigm with higher task load was employed to examine the interaction of anxious level and emotion. Main results as follows: 1. CAPS consisted of 852 pictures was assessed via three dimensionalities, valence, arousal and dominance. The standard deviation of scores on valence and dominance was more than the standard deviation of scores on dimension of arousal. Scatter plot showed that the score distributing on the dimension of valence and arousal was wide in CAPS. 2. In both high and low trait-anxiety groups, the amplitudes of N2 and P3 of negative pictures were greater and smaller respectively as compared with neutral and positive pictures, which suggested all participants no matter what anxious level required more inhibition processing to negative information than others. 3. With increasing of task load, the P3 amplitudes of negative pictures in high anxious group were reduced relative to neutral pictures. In addition, in high anxious group, the P3 amplitudes of positive pictures had the same changes as those of negative ones. Whereas, the reduced P3 of positive pictures were not observed in low anxious group. The results showed the high anxious participants employed the same inhibitory strategy to the positive distracter as the negative distracter, which possibly the over-inhibition processing was involved in this group. 4. Dipole source analysis found cingulate may be involved in executive inhibition processing. In sum, as for the inhibition, high and low anxious group both is sensitive to negative information. However, in the high load situation, due to the shortness of cognitive resources, the high anxious individual represents the general sensitivity to all emotional information. These results gave the electrophysiological evidence for over-inhibition in high trait-anxiety group.

农村留守儿童心理行为现状及其影响因素研究

To investigate the psychological and behavioral status and their influencing factors of children left behind in rural areas in China, 604 students were chosen from primary fifth grade, junior second grade and senior first grade in high schools in local villages and towns of Chongqing and Guizhou to complete some investegations. The results showed that children left behind actually had some internalizing problems including depression, state-trait anxiety, social anxiety, low self-esteem and some social problems in campus; however, they had no delinquency or aggression behaviors. Low parents’ educational level, low life standards, no-good parent-child relationship, the long years parent spent outside, the long time parent spent outside every year, the young age of child when his parent left him, the low contact frequency between parent and child when parent went out for work, all can be the influencing factors made child behave some psychological or behavioral problems. Children left behind need some appropriate psychological intervention, to improve parent-child relationship, to help release internalizing problems and amend interpersonal relationship at school. Several advices may be useful to improve psychological and behavioral problems of children left behind, which are for parents who work outside home not to work long to 10 years, or stay out for work more than 10 months per year, or left child to work when he is younger than two years old, or contact child more than one month after the last contact when work outside home, and you’d better contact child once a day. All of these could be helpful for children left behind to overcome some psychological or behavioral problems.

中学生焦虑与其影响因素的关系模型

Anxiety, which is one of common factors influencing mental health of secondary school students, whose occurrence, development, diagnosis, treatment and intervention have been studied in neurophysiology, behavior and cognition process. in the present study, the relationship between anxieties including trait anxiety and test anxiety and their influencing factors in secondary school students had been explored by exploratory analysis, confirmatory analysis and structure equation modeling. The following conclusions were drawn: (1) There were grade-characteristics in development of trait anxiety in secondary school students. Trait anxiety degree increased with grade. On the other hand, test anxiety showed no grade-characteristics. However, gender differences showed test anxiety in female was higher than in male. In a test, test anxiety increased with test coming and reached the maximum height before test and dropped to the minimum that night after test. (2) Influencing factor inventory on trait anxiety whose reliability and validity were good, has been developed, which was composed of 44 items including 8 factors were study pressure, bad influence of society, self-abased, dysadaptation, introversion, bad body, interrelationship, bad parents raising style etc, of which study pressure was the first reason for trait anxiety. (3) Influencing factor inventory on test anxiety, whose reliability and validity were good, has been developed, which was composed of 30 items including 5 factors. 5 factors were worry about bad school achievement, bad objective environment, intervention of emergency, self-abased, worry about consequence etc, of which study pressure played the most important role on test anxiety. (4) Personality and school pressure affected trait anxiety, while personality and school pressure were affected by environment. Furthermore, test anxiety was affected by worry, personality and, while worry and personality was influenced by spot circumstances. At last, both trait anxiety and test anxiety related with bad personality and bad school achievement.