Symptom structure of posttraumatic stress disorder in a nationally representative sample

Diagnostic criteria (e.g., Diagnostic and Statistical Manual of Mental Disorders, 4th ed.) for posttraumatic stress disorder (PTSD) posit three symptom clusters including reexperiencing, avoidance/numbing, and hyperarousal. Factor analytic studies have suggested several alternative models of PTSD symptomatology. It is uncertain whether these new models are widely generalizable as most studies have relied on relatively select treatment seeking samples (e.g., combat veterans). To address this limitation, confirmatory factor analysis was applied to symptom data from National Comorbidity Survey respondents with a lifetime history of PTSD (n = 429). Several models were tested. The model comprised of four intercorrelated factors (reexperiencing, avoidance, numbing, and hyperarousal) received the strongest support, but did not meet all the goodness-of-fit criteria. A follow-up principal-components analysis yielded a four-factor solution, with factors representing dysphoria, cued reexperiencing and avoidance, uncued reexperiencing and hyperarousal, and trauma-related rumination. The theoretical and clinical implications of these findings are discussed.     

Neurotic butterflies in my stomach: the role of anxiety, anxiety sensitivity and depression in functional gastrointestinal disorders

This study examined the prevalence of functional gastrointestinal (FGI) disorders, and the association between FGI disorders and measures of affective distress, among a sample of 127 university students. Subjects completed a questionnaire battery including Research Diagnostic Questions for Functional Gastrointestinal Disorders, the Beck Anxiety Inventory, the Anxiety Sensitivity Index, the Beck Depression Inventory, and a medical utilization questionnaire. FGI disorders were diagnosed in 51.2% of the sample. Functional dyspepsia (22.8%), dyschezia (20.5%), functional heartburn (19.7%), functional chest pain (18.1%), and globus (12.6%) were the most frequently diagnosed disorders. Participants experiencing globus, functional dyspepsia, or functional heartburn showed significant differences in terms of anxiety, anxiety sensitivity, depression, and/or physician visits, when compared with participants without these disorders. Our results suggest that FGI disorders are strikingly prevalent among young adults, and specific FGI disorders are associated with affective distress. Implications of the observed association between psychological factors and FGI disorders are discussed.     

Brief report: factor structure of the Childhood Illness Attitude Scales (CIAS)

OBJECTIVE: To examine the factor structure of the Childhood Illness Attitude Scales (CIAS). The CIAS is a 35-item self-report measure based on the Illness Attitudes Scales, designed for use with school-age children. The CIAS measures fears, beliefs, and attitudes associated with health anxiety and abnormal illness behavior in childhood. METHODS: CIAS item responses for 201 school-age children were subjected to principal-components analysis with oblique rotation. RESULTS: The CIAS was best conceptualized as comprising four factors: fears, help seeking, treatment experience, and symptom effects. Further factor analysis supported the notion that the CIAS can also be conceptualized as having a hierarchical structure, with four lower-order factors loading onto a single higher-order factor of health anxiety. CONCLUSIONS: Results suggest that the CIAS possesses good psychometric properties, including factorial validity and internal consistency, and appears to be a psychometrically sound instrument for measuring children's health anxiety.     

The Possible Importance of Glutamine Supplementation to Mood and Cognition in Hypoxia from High Altitude

Hypoxia induced by low O₂ pressure is responsible for several physiological and behavioral alterations. Changes in physiological systems are frequent, including inflammation and psychobiological declines such as mood and cognition worsening, resulting in increased reaction time, difficulty solving problems, reduced memory and concentration. The paper discusses the possible relationship between glutamine supplementation and worsening cognition mediated by inflammation induced by high altitude hypoxia. The paper is a narrative literature review conducted to verify the effects of glutamine supplementation on psychobiological aspects. We searched MEDLINE/PubMed and Web of Science databases and gray literature by Google Scholar for English articles. Mechanistic pathways mediated by glutamine suggest potential positive effects of its supplementation on mood and cognition, mainly its potential effect on inflammation. However, clinical studies are scarce, making any conclusions impossible. Although glutamine plays an important role and seems to mitigate inflammation, clinical studies should test this hypothesis, which will contribute to a better mood and cognition state for several people who suffer from problems mediated by hypoxia.     

Contributions of pain-related adjustment and perceptions of control to coping strategy use among cervical sprain patients

Coping is a cyclical process in which an individual evaluates stressful events, chooses and implements coping strategies, re-evaluates the outcome of the coping effort and modifies the strategy if necessary. The intent of the present study was to evaluate the extent to which pain-related adjustment (i.e. pain severity, pain interference, negative affect) and perceptions of control are associated with the implementation of particular coping strategies. Participants were 136 patients assessed at an interdisciplinary pain clinic for cervical sprain injuries. As part of a routine assessment, participants completed a questionnaire package regarding background, pain severity, pain interference, negative affect, perceived control and use of particular coping strategies. Results of hierarchical multiple regression analyses revealed that pain interference, after controlling for all other variables, was associated with greater use of less physically demanding strategies (i.e. resting, guarding, asking for assistance, seeking social support and coping self-statements). Negative affect, on the other hand, after controlling for other variables, was associated with reduced use of task persistence. Finally, perceived control, independent of other variables, was associated with greater use of cognitive and social coping strategies (i.e. asking for assistance, seeking social support and coping self-statements). The results of the study shed light on the complex relationship between use of particular coping strategies and situational variables of pain-related adjustment and perceived control. Implications for clinicians who assist patients via implementation or modification of particular coping techniques are discussed.     

Factorial validity of the short-form McGill pain questionnaire (SF-MPQ).

Although widely used, there have been few investigations of the factorial validity of the short-form McGill Pain Questionnaire (SF-MPQ; Melzack, 1987). Confirmatory factor analysis was performed on item responses to the SF-MPQ obtained from 188 patients with chronic back pain. Consistent with the original structure proposed by Melzack (1987), results indicated that the SF-MPQ is best represented by a two-factor solution. However, these findings are contrary to results obtained by Burckhardt and Bjelle (1994) who, using their Swedish version of the SF-MPQ, obtained a three-factor solution. Potential explanations for the disparity between the results of the two studies are explored and recommendations for continuing clinical and research applications are offered.     

Rett syndrome from quintuple and triple deletions within the MECP2 deletion hotspot region

Rett syndrome results from mutations in the X-linked methyl-CpG-binding protein 2 (MECP2) gene, which are nearly always lethal in males and lead to regression and reduced life expectancy in females. Herein we report one propositus with five tandem deletions and a second propositus with three tandem deletions within MECP2 exon 4 that encode truncated protein products resulting in classic Rett syndrome. These deletion breakpoints and single deletions in 3 other patients were all found within a 185-bp region along with 64 of 69 other reported deletion breakpoints in the MECP2 gene. Illegitimate recombination resulting in deletion at a substantial proportion of the shared MECP2 sites is enhanced by repeated guanosine (G) DNA sequences in the antisense direction, consistent with reports at other gene loci that polypurine (multiple guanosine or adenosine (A)) basepairs enhance sequence deletion. Multiple deletions at the same poly G recombination sites confirm the existence of deletion hotspots in this gene region with numerous repeated antisense sites that are enriched 26- to 161-fold. Deletion by illegitimate recombination within a single allele can occur during mitotic or meiotic cell cycles. Although prone to disease-causing deletion, this region is unique in humans and highly conserved among mammals for the last 75 000 000 years to maintain the MECP2 gene's critical function.     

Factorial Validity of the English-Language Version of the Pain Catastrophizing Scale–Child Version

The Pain Catastrophizing Scale (PCS) was developed in English to assess 3 components of catastrophizing (rumination, magnification, helplessness). It has been adapted for use and validated with Flemish-speaking children (Pain Catastrophizing Scale for Children [PCS-C]) and French-speaking adolescents. The PCS-C has been back-translated to English and used extensively in research with English-speaking children; however, the factorial validity of the English PCS-C has not been empirically examined. This study assessed the factor structure of the English PCS-C among a community sample of 1,006 English-speaking children (aged 8–18 years). Exploratory factor analysis was conducted using a random subsample (n = 504) to assess the underlying factor structure. Items with poor factor loadings were removed. Confirmatory factor analysis, using the second subsample (n = 502), was used to cross-validate the factor structure revealed by exploratory factor analysis and compare it to the original 3-factor model and other model variants. Exploratory factor analysis revealed that the original PCS-C and a revised 3-factor model comprising 11 of the original 13 PCS-C items, all loading on their original factors, provided adequate fit to the data. The revised model provided statistically better fit to the data compared to all other model variants, suggesting that the English PCS-C may be better understood using a revised 11-item oblique 3-factor model.     

Prevalence and risk indicators of oral mucosal lesions in an urban population from South Brazil

Oral Diseases (2011) 17 , 171–179 Objective: The objective of the study was to assess the prevalence of oral mucosal lesions (OML) and to perform a multivariable risk assessment of demographic, socioeconomic, behavioral, and oral risk indicators for its occurrence in an urban population in South Brazil. Methods: This cross‐sectional study selected 1586 subjects (719M/867F, age: 14–104 years) using a multistage probability sampling strategy (65.1% response rate). Prevalence, odds ratios (OR), and confidence intervals (95% CI) were calculated accounting for the survey design. Results: Leukoplakia and lichen planus were observed in 1.01% and 1.02% of subjects, respectively. In the multivariable analysis, these lesions were significantly associated with moderate/heavy smoking (OR = 9.0, 95% CI = 2.1–39.1) and heavy drinking (OR = 2.0, 95% CI = 1.1–3.7). Candidiasis and proliferative lesions were observed in 14.09% and 3.80% of the subjects, respectively. These lesions were significantly associated with female gender (OR = 2.2, 95% CI = 1.5–3.2 and OR = 1.7, 95% CI = 1.0–2.8), older age (OR = 22, 95% CI = 8.0–60.8 and OR = 8.9, 95% CI = 3.4–23.7), and low socioeconomic status (OR = 1.9, 95% CI = 1.0–3.5 and OR = 3.0, 95% CI = 1.2–7.2). Conclusions: This population is in need of OML prevention and treatment. Future studies should validate the findings that premalignant lesions are causally related to smoking and alcohol consumption, and that other OML are associated with socioeconomic‐demographic disparities in this and similar populations.     

An examination of the relation between conduct disorder, childhood and adulthood traumatic events, and posttraumatic stress disorder in a nationally representative sample

Background

Clinical data has indicated that exposure to trauma and meeting diagnostic criteria for posttraumatic stress disorder (PTSD) are common among individuals with a history of conduct disorder. However, these relationships have not been adequately examined in a population-based sample.

Methods

Data were drawn from Wave 2 of the U.S. National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) collected in 2004–2005 (n = 34,653, response rate = 86.7%). Multivariate logistic regression analyses were conducted to examine relations between conduct disorder, traumatic life events, and PTSD in the full sample, and separately for males and females.

Results

The main findings indicate that childhood maltreatment was associated with conduct disorder (Adjusted Odds Ratio [AOR] ranging from 2.4 to 4.7) after adjustment for sociodemographic variables. Additionally, respondents with a history of conduct disorder compared to respondents without conduct disorder were more likely to report experiencing any traumatic event (AOR = 2.7, 95% CI = 2.0–3.6) and PTSD (AOR = 2.2, 95% CI = 1.8–2.7) after adjusting for sociodemographic variables. Although sex differences were noted, conduct disorder was associated with the greatest odds of assaultive violence for males and females. The majority of individuals (72.9%) diagnosed with both conduct disorder and PTSD developed conduct disorder symptoms before PTSD symptoms.

Conclusions

Results of this study provide the first known sex-stratified examination of the relationship between conduct disorder, traumatic events, and PTSD in a large, population-based sample of adults and are consistent with clinical impressions. Policy and clinical implications are discussed.