Impact of Mindfulness-Based Cognitive Therapy on Intolerance of Uncertainty in Patients with Panic Disorder

Objective

Intolerance of uncertainty (IU) is a transdiagnostic construct in various anxiety and depressive disorders. However, the relationship between IU and panic symptom severity is not yet fully understood. We examined the relationship between IU, panic, and depressive symptoms during mindfulness-based cognitive therapy (MBCT) in patients with panic disorder.

Methods

We screened 83 patients with panic disorder and subsequently enrolled 69 of them in the present study. Patients participating in MBCT for panic disorder were evaluated at baseline and at 8 weeks using the Intolerance of Uncertainty Scale (IUS), Panic Disorder Severity Scale-Self Report (PDSS-SR), and Beck Depression Inventory (BDI).

Results

There was a significant decrease in scores on the IUS (p<0.001), PDSS (p<0.001), and BDI (p<0.001) following MBCT for panic disorder. Pre-treatment IUS scores significantly correlated with pre-treatment PDSS (p=0.003) and BDI (p=0.003) scores. We also found a significant association between the reduction in IU and PDSS after controlling for the reduction in the BDI score (p<0.001).

Conclusion

IU may play a critical role in the diagnosis and treatment of panic disorder. MBCT is effective in lowering IU in patients with panic disorder.     

The role of dialect density in nonword repetition performance: An examination with at-risk African American preschool children

The Nonword Repetition Task (NRT) is considered to be a less-biased language measure for children from cultural minority groups. In the current study, we examined NRT performance of 50 at-risk, preschool-age children who spoke African American English (AAE). In addition to the NRT, measures included AAE dialect density and several standardised language tests. The primary aim was to determine significant contributors to NRT performance. We hypothesised that the language measures would significantly contribute to NRT performance while dialect density would be an insignificant contributor. Contrary to our predictions, dialect density was a unique and significant predictor of NRT performance (in addition to phonological awareness), while the language measures were not significant predictors. The current findings cast doubt on categorising the NRT as a less-biased language assessment for AAE-speaking preschoolers; however, the NRT may have potential as a screener for identifying preschoolers at risk for delays in literacy acquisition.     

Cognitive function in UK community-dwelling African Caribbean elders: normative data for a test battery

Many 'first generation' African Caribbean residents in the UK have now reached ages where risk of cognitive impairment and dementia starts to increase. In addition, conditions which may impair cognitive function, such as hypertension, diabetes and stroke, have high prevalence rates in African Caribbean populations. However, there is a lack of normative data for cognitive tests in this ethnic group. Cognitive assessment was carried out in a south London community population of 285 African Caribbean participants aged 55-75 years. Tests were drawn principally from the consortium to establish a registry for Alzheimer's disease (CERAD) battery (Boston Naming Test, verbal fluency, word list recall, and Trailmaking Tests A and B) and also included orientation items from the Mini-Mental State Examination (MMSE) and the Clock Drawing Test. Independent effects of age, sex, education and occupation were identified on scores for most but not all cognitive tests. Compared with normative data for African American populations, lower scores on verbal fluency and the Boston Naming Test were observed but scores on memory tests were comparable. Normative data for the tests are presented, stratified by level of education.     

Valproate Adjuvant Cognitive Behavioral Therapy in Panic Disorder Patients With Comorbid Bipolar Disorder: Case Series and Review of the Literature

Anxiety disorders are the most common comorbid psychiatric disorders in patients with bipolar disorder. Managing anxiety symptoms in comorbid conditions is challenging and has received little research interest. The findings from preclinical research on fear conditioning, an animal model of anxiety disorder, have suggested that memory reconsolidation updating (exposure-based therapy) combined with valproate might facilitate the amelioration of fear memories. Here, three cases of successful amelioration of agoraphobia and panic symptoms through valproate adjuvant therapy for cognitive behavioral therapy in patients who failed to respond to two to three consecutive standard pharmacotherapy trials over several years are described. To the best of the author’s knowledge, this is the first attempt to combine CBT with valproate in patients with panic disorder, agoraphobia, and comorbid bipolar disorder. Additionally, the background preclinical research on this combination therapy based on the reconsolidation-updating mechanism, the inhibition of histone deacetylase 2, and critical period reopening, off-label use of valproate in panic disorder, plasticity-augmented psychotherapy, and how to combine valproate with CBT is discussed.     

Use of the Beck Depression Inventory-II with African American primary care patients

The Beck Depression Inventory-II (BDI-II) is one of the most common self-report instruments used for depression screening. However, there is a lack of research examining the effectiveness of this instrument in detecting depression in an African American primary care sample. The current study included 220 African American primary care patients who completed the BDI-II and were administered a diagnostic interview to establish depressive diagnoses. Results indicated that depressed patients demonstrated significantly greater BDI-II total scores compared to non-depressed patients. The recommended cutoff score of 14 for screening for depression appears to be appropriate for African American patients in the primary care setting. This cutoff yielded sensitivity of 87.7% and specificity of 83.9%. Positive predictive value of the BDI-II was .70, and negative predictive value was .94. Similar to findings with predominantly Caucasian samples, current results suggest the BDI-II is an appropriate and accurate instrument to use for depression screening among African American primary care patients.     

Serum S100B Protein Levels in Patients with Panic Disorder: Effect of Treatment with Selective Serotonine Reuptake Inhibitors

ObjectiveAltered serum S100B protein levels have been shown in several psychiatric disorders. Our aim was to investigate whether plasma S100B is different in patients with panic disorder (PD) when compared with controls. Our second aim was to investigate whether treatment with SSRIs have an effect on S100B levels in patients with PD.MethodsThe sample included 32 patients diagnosed with PD (21 women, 11 men) per DSM-IV criteria and 21 healthy controls (11 women, 10 men). S100B levels were measured with BioVendor Human S100B ELISA (Enzyme Linked Immunosorbent Assay) kit.Results14 patients were not on drug treatment (43.8%) while 18 patients were taking various SSRIs. Median S100B value was 151.7 pg/mL (minimum-maximum: 120.4-164.7 pg/mL) in the control group, 147.4 pg/mL (minimum-maximum: 138.8-154.1 pg/mL) in the drug free group and 153.0 pg/mL (minimum-maximum: 137.9-164.7 pg/mL) in the treatment group. Kruskal-Wallis analysis showed a significant diffrerence among the three groups (z=9.9, df=2, p=0.007). Follow up Mann-Whitney-U tests indicated that while the control and the patients with treatment were not significantly different (z=-0.05, p=0.96), there were significant differences between the control group and untreated patients (z=-2.6, p=0.009) and treated and untreated patients (z=-3.0, p=0.003).ConclusionOur results suggested that, serum S100B protein level might be decreased in untreated PD patients and that patients who were treated with SSRIs had similar S100B level to healthy controls.     

Factor Structure and Psychometric Properties of the Multidimensional Anxiety Scale for Children in an African American Adolescent Sample

The current study examined the psychometric properties and factor structure of the Multidimensional Anxiety Scale for Children (MASC) among a community sample of 118 African American students (58 females; ages 14’19 years; mean age = 15.79) in an urban, parochial high school. Adolescents completed the MASC and several other self-report measures of anxiety, perceived competence, and symptoms of ADHD. The original MASC total and subscale mean scores were comparable to data reported in previous studies utilizing community samples of youth, though measures of internal consistency were lower. Factor analytic results supported a three factor solution (i.e., social anxiety, physical symptoms, harm avoidance) which accounted for 23.84% of the variance. While there was overlap in the underlying structure of anxiety between the original MASC publication and the current sample, items reflecting separation anxiety did not emerge as a separate factor. As expected, the MASC total score was positively correlated with measures of anxiety and perceived competence but unrelated to measures of hyperactivity. This study represents an important first step toward establishing more comprehensive age, race, and gender norms for the MASC.     

Psychometric properties of the social phobia and social interaction anxiety scales: Evidence of construct equivalence in an African American sample

This study evaluated the psychometric properties of the Social Phobia Scale and Social Interaction Anxiety scale in a community sample of African Americans. We conducted a confirmatory factor analysis of the combined scales comparing the data to 2- and 3-factor solutions commonly reported in the literature. The results indicated that neither solution produce an adequate fit to the data in this study. We then proceeded to conduct an exploratory factor analysis within a confirmatory framework of both scales. While we were able to extract a 2-factor solution from the data, the item composition of the factors was somewhat different for African Americans than what is typically reported in non-Hispanic White samples. While we conclude that use of the two social anxiety scales is warranted, we make recommendations regarding the interpretation of both scales with African Americans.     

Brief report: The number of sexual partners and race-related stress in African American adolescents: Preliminary findings

The current study examined the association between the number of lifetime sexual partners and race-related stress among African American 201 high school juniors and seniors at two urban high schools in the Southeastern region of the country. Students completed the Index of Race-Related Stress-Brief (IRRS-B) and the Youth Risk Behavior Survey (YRBS). African American male adolescents reported higher race-related stress and a higher number of sexual partners compared to African American females. Controlling for gender and age of first intercourse, race-related stress significantly predicted the number of sexual partners for African American adolescents. Preliminary findings indicate that the role of race-related stress may prove critical in decreasing risky sexual behavior among African American adolescents.     

Clinical Features in Panic Disorder with Agoraphobia: A Comparison of Men and Women

This study compared 96 women and 58 men suffering from panic disorder with agoraphobia. Participants completed questionnaires assessing various clinical features associated with panic disorder with agoraphobia (PDA), general adjustment, and drug/alcohol use. Results showed that PDA is a more severe condition in women. Women reported more severe agoraphobic avoidance when facing situations or places alone, more catastrophic thoughts, more body sensations, and higher scores on the Fear Survey Schedule. Also, women more often had a comorbid social phobia or posttraumatic stress disorder. The lower agoraphobic avoidance of men was associated with their alcohol use. However, there were no differences between genders in other dimensions, including depression, situational and trait anxiety, stressful life events, social self-esteem, marital adjustment, and drug use.     

Evidence for a minimal competence core of consonant sounds in the speech of African American children: A preliminary study

Most studies have stressed those aspects of African American English (AAE) that differ from Standard English (SE) varieties. Therefore word‐ final consonant performance has been investigated most often. In contrast, this intensive study aimed to reveal whether a common core of initial consonants is used by typically developing AAE children at or close to the 3^rd birthday. More than 2000 phonetically transcribed utterances were extracted from the audiovisual archives of natural samples of speech for seven children. All seven children met the productivity criterion for a shared core of 15 sounds in their repertoire of correctly produced word‐initial consonants. The children also met the criterion for using word‐initial consonant clusters or blends that commonly included the stop+sonorant type. The results provided preliminary evidence for a minimal competence core of word‐initial consonants that is consistent with developmental data on typically developing speakers of SE and other languages besides English. Sample sizes of more than 50 spontaneous utterances were required to elicit these core features. Research and clinical implications of these results are discussed.     

The Effects of 5-HTR1A Polymorphism on Cingulum Connectivity in Patients with Panic Disorder

Objective

Serotonin-1A receptors (5-HTR1A) is suggested to be involved in the etiology of several psychiatric disorders including panic disorder (PD). A few imaging studies have suggested the alterations of the cingulum bundle in PD. The objective of this study is to examine the structural changes of cingulum related to the 5-HTR1A polymorphism rs6295 in the patients with PD.

Methods

Thirty-two right-handed patients with PD [11 men, 21 women; 40.34±13.17 (mean±SD) age] who met the diagnostic criteria in Structured Clinical Interview for DSM-IV were examined by means of MRI at 3 Tesla. We divided the patients with PD into CC genotype group and non CC genotype group (GG/CG genotype group) of the 5-HTR1A rs6295 polymorphism to compare the cingulum white matter connectivity.

Results

Tract-based spatial statistics showed significantly increased fractional anisotropy (FA) values in cingulate gyrus process of left cingulum in 5-HTR1A CC genotype compared to GG/CG genotype in PD. Significant positive correlations were shown between the Albany Panic and Phobia Questionnaire (APPQ) interoceptive fear subscale scores, the Anxiety Sensitivity Inventory-Revised fear of publicly observable anxiety reaction subscale scores and FA values of cingulate gyrus process of left cingulum in 5-HTR1A rs6295 GG/CG genotype group. In CC genotype group, APPQ total, APPQ agoraphobia subscale and APPQ social phobia subscale scores also showed significant positive correlations with FA values of hippocampal process of right cingulum.

Conclusion

This preliminary study suggests that 5-HTR1A polymorphism may be associated with the cingulum white matter connectivity in PD.     

School and peer influences on the academic outcomes of African American adolescents

Little scholarship explores how adolescents' beliefs about school and peers influence the academic outcomes of African American boys and girls. The sample included 612 African American boys (N = 307, M_age = 16.84) and girls (N = 305, M_age = 16.79). Latent class analysis (LCA) revealed unique patterns for African American boys and girls. Findings indicate that for African American boys, school attachment was protective, despite having peers who endorsed negative achievement values. Furthermore, socio-economic (SES) status was associated with higher grade point averages (GPA) for African American girls. Overall, these findings underscore the unique role of school, peer, and gendered experiences in lives of African American adolescents.     

Rates of auxiliary is and are in African American English speaking children with specific language impairment following language treatment

The purpose of this exploratory study is to examine rates of auxiliary is and are across dialect patterns produced by African American English with specific language impairment (AAE-SLI) children following language treatment. The following research question is asked: Do AAE-SLI children exhibit rates of auxiliary is and are across dialect patterns consistent with previous reports of typically developing children and adult AAE speakers? A pre-/post-test design was used to identify patterns in which auxiliary is and are were produced at significant levels. Individual performance was included to examine variable rates of use across patterns. Group and individual results suggest children used auxiliary is and are in dialect patterns at rates consistent with typically developing child and adult AAE speakers. We conclude that rates of use may contribute to evidence-based guidelines for morphological intervention with AAE-SLI children.     

Eligibility,Recruitment, and Retention of African Americans with Severe Mental Illness in Community Research

Data that addresses severely mentally ill (SMI) African Americans (AAs) likelihood to participate in clinical research is limited. This study’s purpose was to determine if differences exist between races regarding eligibility, recruitment, and retention in a community-based clinical trial. The sample included 293 participants. Data sources included clinical records and interviews. Logistic regression was used for analysis. AAs were as likely to participate and to complete followup interviews as Whites. In contrast to studies about non-mentally ill AAs, AAs with SMI appeared to be as willing to consent to and to remain in clinical research studies as Whites.