Liver disease in haemophiliacs: an overstated problem?

S ummary. Successful percutaneous liver biopsy was carried out on 12 multi-transfused haemophiliacs from the Manchester area with persistently abnormal liver function tests. Only one patient showed evidence of chronic active hepatitis with progression to active micronodular cirrhosis although a further four patients showed some evidence of mild chronic active hepatitis. This represents a much lower incidence of severe histological liver damage than many previous reports and implies that liver biopsy in asymptomatic haemophiliacs may not be indicated as a routine procedure, particularly in the absence of proven therapy. Dynamic liver function tests may prove to be a useful indicator of deteriorating liver function in the otherwise asymptomatic haemophiliac.     

Issues of measurement and mechanism in meta-analyses: comment on Westen and Morrison (2001).

The authors suggest that D. Westen and K. Morrison's (2001) meta-analysis of treatment is critically limited in the consideration of measurement and mechanisms of therapeutic change. The measures included in the analysis fail to represent a comprehensive coverage of the domains within which change is expected. Moreover, they do not measure the theoretically derived constructs currently conceived as being central to each disorder. Further, the particular meta-analytical approach taken prohibits evaluation of the treatment components responsible for change. The authors reviewed the most recent data on comorbidity as an issue of treatment efficacy and generalizability, proffer an interpretation for the difference in outcome results across the 3 diagnostic groups, and discuss internally valid methodologies for the bridging from research to clinical practice.     

Sex-related differences in prepulse inhibition of startle in irritable bowel syndrome (IBS)

Alterations in central networks involved in the regulation of arousal, attention, and cognition may be critical for irritable bowel syndrome (IBS) symptom maintenance and exacerbation. Differential sensitivities in these networks may underlie sex differences noted in IBS. The current study examined prepulse inhibition (PPI), a measure of sensorimotor gating, in male and female IBS patients. Relationships between PPI and symptom severity were examined, as well as potential menstrual status effects. Compared to healthy controls, male IBS patients had significantly reduced PPI; whereas female IBS patients (particularly naturally cycling women) had significantly enhanced PPI suggesting hypervigilance. Considering previously demonstrated sex-related differences in perceptual and brain imaging findings in IBS patients, the current findings suggest that different neurobiological mechanisms underlie symptom presentation in male and female IBS patients. Compromised filtering of information in male IBS patients may be due to compromised top down (prefrontal, midcingulate) control mechanisms while increased attention to threat due to increased limbic and paralimbic circuits may be characteristic of female IBS patients.     

A randomized controlled trial of aromatherapy massage in a hospice setting

Research suggests that patients with cancer, particularly in the palliative care setting, are increasingly using aromatherapy and massage. There is good evidence that these therapies may be helpful for anxiety reduction for short periods, but few studies have looked at the longer term effects. This study was designed to compare the effects of four-week courses of aromatherapy massage and massage alone on physical and psychological symptoms in patients with advanced cancer. Forty-two patients were randomly allocated to receive weekly massages with lavender essential oil and an inert carrier oil (aromatherapy group), an inert carrier oil only (massage group) or no intervention. Outcome measures included a Visual Analogue Scale (VAS) of pain intensity, the Verran and Snyder-Halpern (VSH) sleep scale, the Hospital Anxiety and Depression (HAD) scale and the Rotterdam Symptom Checklist (RSCL). We were unable to demonstrate any significant long-term benefits of aromatherapy or massage in terms of improving pain control, anxiety or quality of life. However, sleep scores improved significantly in both the massage and the combined massage (aromatherapy and massage) groups. There were also statistically significant reductions in depression scores in the massage group. In this study of patients with advanced cancer, the addition of lavender essential oil did not appear to increase the beneficial effects of massage. Our results do suggest, however, that patients with high levels of psychological distress respond best to these therapies.     

Facilitating Symptom Reduction and Behavior Change in GAD: The Issue of Control

In this commentary we review the theoretical positions of Roemer and Orsillo and identify several key issues. First, the specificity of their arguments to generalized anxiety disorder (CAD) compared to the other anxiety disorders are explored. For example, the proposed distinctions between worry in CAD and worry associated with the other anxiety disorders are examined in light of available empirical evidence. Second, the proposed disjunctions between mental content and both actual experience and emotional/physiological responding are placed in the context of current theoretical and empirical work. Finally, possible therapeutic mechanisms of change for mindfulness/acceptance-based treatments and the roles of control and predictability in anxiety disorder treatment are discussed.     

Dysregulation of threat neurocircuitry during fear extinction: the role of anhedonia

Dimensional models of anxiety and depression highlight common and distinct symptom clusters that are thought to reflect disruptions in underlying functional processes. The current study investigated how functioning of threat neurocircuitry relates to symptom dimensions of anxiety and depression. Participants were aged 18–19 years (n = 229, 158 female) and were selected to ensure a range of scores on symptom measures. Symptom dimensions of “General Distress” (common to anxiety disorders and depression), “Fears” (more specific to anxiety disorders), and “Anhedonia-apprehension” (more specific to depression) were evaluated. Participants underwent functional magnetic resonance imaging during a Pavlovian fear conditioning paradigm. Multilevel modeling analyses estimated relationships between symptom dimensions and activation in threat neural circuitry. Exploratory whole brain analyses were also conducted. Threat-related neural activity was not associated with General Distress or Fears. Anhedonia-apprehension was associated with activation of bilateral amygdala, anterior insula and dACC during late extinction. We found no evidence to support an association between symptom dimensions of General Distress or Fears with threat circuitry activation in a large sample of young adults. We did, however, find that the symptom dimension of Anhedonia-apprehension was significantly associated with threat-related neural activation during fear extinction. This effect requires replication in future work but may reflect anhedonic impairments in learning when contingencies are altered, possibly linked to the rewarding relief of an unexpectedly absent threat.Subject terms: Emotion, Limbic system     

Emotional variability and sustained arousal during exposure

Background and objectivesIn traditional exposure therapy for phobias and anxiety disorders, reduction of fear responding is used as an index of learning. However, recent evidence in animal models suggests that sustained arousal and enhanced fear responding throughout exposure may actually predict better long-term outcomes (Rescorla, 2000).MethodsThe effects of sustained arousal during exposure were investigated in a clinical analog sample of 59 participants fearful of public speaking. Participants completed exposure with or without the presence of additional excitatory stimuli which were intended to enhance arousal and fear responding throughout exposure.ResultsGroup assignment (exposure versus exposure with additional excitatory stimuli) did not significantly predict outcome at 1-week follow-up testing, as measured physiologically, subjectively, and behaviorally. A set of regression analyses investigating whether any exposure process measures predicted outcome indicated that sustained arousal throughout exposure as well as variability in subjective fear responding throughout exposure (e.g., Kircanski et al., 2011) predicted lower levels of fear at follow-up testing (p < 0.05; p < 0.001) after controlling for demographic variables as well as pre-exposure fear levels.LimitationsThe excitatory stimuli used failed to produce the intended effects. However, some participants did maintain elevated arousal throughout exposure and this predicted better outcomes at 1-week follow-up testing.ConclusionsSustained arousal throughout exposure as well as variability in subjective fear responding during exposure may be better predictors of long-term outcomes than habituation of fear across exposure.