The search for universal transdiagnostic and trans-therapy change processes: Evidence for intolerance of uncertainty

The search for universal processes associated with symptom change across emotional disorders and different forms of psychotherapy offers hope of increased theoretical parsimony and treatment efficiencies. This study investigated whether intolerance of uncertainty (IU) is a universal process by examining whether changes in IU were associated with changes in symptoms across three different cognitive behavior therapy protocols for depression (n = 106), social anxiety disorder (n = 88), or generalized anxiety disorder (n = 62) in a community mental health clinic. IU was associated with reductions in repetitive negative thinking in all treatments, which is consistent with IU being a transdiagnostic and ‘trans-therapy’ process of change. Changes in IU were also associated with symptom relief in the social anxiety disorder and generalized anxiety disorder groups, but not in the depression group. Implications of these findings are discussed within the broader literature of transdiagnostic approaches to emotional disorders.     

Acute dermatomyositis associated with generalized subcutaneous edema

Generalized subcutaneous edema is an uncommon manifestation of inflammatory myopathy. We report a 48-year-old female patient who presented with severe generalized edema, an erythematous skin rash, dysphagia and proximal muscle weakness. She was diagnosed with dermatomyositis from the clinical signs, increased muscle enzymes, electromyographic findings and a muscle biopsy. Magnetic resonance imaging revealed increased signal intensity in the muscular and subcutaneous layers. The conditions causing generalized edema were excluded. It was concluded that the generalized edema was secondary to dermatomyositis. Aggressive treatments with high-dose glucocorticoids and immunosuppressive agents were used to control the severe subcutaneous edema.     

钾通道Kv1.2与致痫大鼠发病相关性的研究

目的通过检测戊四唑(PTZ)致痫大鼠钾通道Kv1.2蛋白表达,探讨钾通道Kv1.2与癫痫发病的相关性。方法 40只SD大鼠分成实验组30只和正常对照组10只。实验组30只大鼠通过腹腔注射PTZ建立全身强直阵挛发作大鼠癫痫模型,取成功致痫鼠24只均分成3组,分别于致痫后3个时间段(1h、24h、48h)取脑组织。用免疫组化法和Western blot法检测大鼠钾通道Kv1.2蛋白。结果实验组大鼠海马区钾通道Kv1.2蛋白表达水平在致痫后3个时间段(1h、24h、48h)均明显低于对照组(P0.05)。实验组大鼠海马区钾通道Kv1.2蛋白表达水平在致痫后3个时间段(1h、24h、48h)之间无显著性差异(P0.05)。结论大鼠海马区钾通道Kv1.2表达的减少与全身强直阵挛发作大鼠癫痫发病密切相关。     

心理治疗联合黛力新治疗广泛性焦虑症的疗效观察

目的探讨心理治疗联合黛力新治疗广泛性焦虑症的临床疗效。方法将82例广泛性焦虑症患者随机分为两组：心理治疗联合黛力新治疗组（心理治疗组）和黛力新治疗组（药物治疗组）,进行1年的疗效观察,分别采用Zung焦虑量表（SAS）和Hamil-ton编制的汉密顿焦虑量表14项（HAMA）进行评定。结果心理治疗组分别在第6周和第12周末的SAS、HAMA评分较药物治疗组差异具有统计学意义（P〈0.01）,1年后的随访心理治疗组的复发率低于药物治疗组（P〈0.05）。结论心理治疗联合黛力新治疗焦虑症的疗效优于单用黛力新,且复发率低,值得在临床上广泛推广使用。     

Shared genetic contributions to anxiety disorders and pathological gambling in a male population

Background

Pathological gambling (PG) frequently co-occurs with anxiety disorders. However, the extent to which the co-occurrence is related to genetic or environmental factors across PG and anxiety disorders is not known.

Method

Data from the Vietnam Era Twin Registry (n = 7869, male twins) were examined in bivariate models to estimate genetic and shared and unique environmental contributions to PG and generalized anxiety disorder (GAD) and PG and panic disorder (PD).

Results

While both genetic and unique environmental factors contributed individually to PG, GAD, and PD, the best fitting model indicated that the relationship between PG and GAD was attributable predominantly to shared genetic contributions (r_A = 0.53). In contrast, substantial correlations were observed between both the genetic (r_A = 0.34) and unique environmental (r_E = 0.31) contributions to PG and PD.

Limitations

Results may be limited to middle aged males.

Conclusions

The existence of shared genetic contributions between PG and both GAD and PD suggests that specific genes, perhaps those involved in affect regulation or stress responsiveness, contribute to PG and anxiety disorders. Overlapping environmental contributions to the co-occurrence of PG and PD suggest that common life experiences (e.g., early life trauma) contribute to both PG and PD. Conversely, the data suggest that distinct environmental factors contribute to PG and GAD (e.g., early onset of gambling in PG). Future studies should examine the relationship between PG and anxiety disorders amongst other populations (women and adolescents) to identify specific genetic and environmental influences that account for the manifestation of these disorders and their co-occurrences.     

A meta-analysis of the relation of intolerance of uncertainty to symptoms of generalized anxiety disorder, major depressive disorder, and obsessive-compulsive disorder

Intolerance of uncertainty (IU) has been suggested to reflect a specific risk factor for generalized anxiety disorder (GAD), but there have been no systematic attempts to evaluate the specificity of IU to GAD. This meta-analysis examined the cross-sectional association of IU with symptoms of GAD, major depressive disorder (MDD), and obsessive-compulsive disorder (OCD). Random effects analyses were conducted for two common definitions of IU, one that has predominated in studies of GAD (56 effect sizes) and another that has been favored in studies of OCD (29 effect sizes). Using the definition of IU developed for GAD, IU shared a mean correlation of .57 with GAD, .53 with MDD, and .50 with OCD. Using the alternate definition developed for OCD, IU shared a mean correlation of .46 with MDD and .42 with OCD, with no studies available for GAD. Post-hoc significance tests revealed that IU was more strongly related to GAD than to OCD when the GAD-specific definition of IU was used. No other differences were found in the magnitude of associations between IU and the three syndromes. We discuss implications of these findings for models of shared and specific features of emotional disorders and for future research efforts.     

帕罗西汀对青年广泛性焦虑心率变异性的影响

目的探讨帕罗西汀对青年广泛性焦虑（GAD）患者心率变异性（HRV）的影响。方法选取80例GAD患者,随机分为研究组与对照组,两组患者均进行心理治疗,研究组在心理治疗基础上联合帕罗西汀20 mg/d治疗。分别于入组时、治疗4周后使用24 h动态心电图仪测定HRV,并进行汉密顿焦虑量表（HAMA）评分。结果治疗后研究组及对照组HRV时域、频域指标均较治疗前升高（P〈0.05）,研究组较对照组升高更明显（P〈0.05）;两组治疗后HAMA总分均较治疗前下降（P〈0.05）,研究组较对照组下降更明显（P〈0.05）。结论帕罗西汀能提高广泛性焦虑患者副交感神经的活动,同时降低交感神经的活动,改善交感-迷走均衡性。     

帕罗西汀治疗对广泛性焦虑昼夜心率变异性的影响

目的探讨帕罗西汀治疗后广泛性焦虑患者心率变异性昼夜节律变化。方法 43例广泛性焦虑患者接受盐酸帕罗西汀治疗4周。分别于治疗前、治疗后进行24h动态心电图监测及心率变异性分析。结果治疗前日间与夜间SDNN、SDANN、rMSSD、PNN50比较,差异无统计学意义。治疗后日间与夜间比较,四个参数比较差异有统计学意义。结论帕罗西汀可以改善广泛性焦虑患者自主神经的昼夜节律性。     

帕罗西汀联合阿普唑仑治疗广泛性焦虑症的疗效观察

目的探讨帕罗西汀联合阿普唑仑治疗广泛性焦虑症患者的疗效,关注其对焦虑和抑郁评分的影响,以期为临床工作提供帮助。方法收集本院诊治的广泛性焦虑症的患者80例,随机分为观察组（40例）与对照组（40例）,对照组单纯应用帕罗西汀治疗,观察组应用帕罗西汀联合阿普唑仑治疗,观察治疗对患者焦虑和抑郁评分的影响。结果观察组在治疗2、4、8周后对焦虑和抑郁的改善情况明显优于对照组,两组差异有统计学意义（P〈0.05）。结论帕罗西汀联合阿普唑仑治疗广泛性焦虑症患者的疗效明显,对焦虑和抑郁改善的效果理想,临床中可以积极应用。