Vibrio vulnificus Septicemia After Handling Tilapia Species Fish: A Canadian Case Report and Review.

BACKGROUND: Vibrio vulnificus can cause a necrotizing soft tissue infection or primary septicemia; these infections are collectively known as vibriosis. This bacterium is commonly found within molluscan shellfish. Primary septicemia is often fatal, principally affecting persons with chronic liver disease. CASE PRESENTATION: A fatal case of V vulnificus sepsis that developed in a patient with chronic hepatitis B and chronic renal failure is reported. Diagnosis was made by isolation of the pathogen by blood culture. Upon further questioning, the patient's family recounted that the patient had handled and ingested Tilapia species fish in the hours preceding the patient's presentation. Despite treatment with doxycycline and cefotaxime, in conjunction with supportive care in the intensive care unit, the patient died on day 7 from multiple organ dysfunction. CONCLUSION: The present case highlights the need to consider V vulnificus in the microbiological differential diagnosis when a person presents with sepsis and bullous cutaneous lesions. The importance of educating patients with liver disease (and certain other chronic diseases) about the need to be cautious when handling or consuming seafood is underscored.     

Eye tracking of attention in the affective disorders: A meta-analytic review and synthesis

A large body of research has demonstrated that affective disorders are characterized by attentional biases for emotional stimuli. However, this research relies heavily on manual reaction time (RT) measures that cannot fully delineate the time course and components of attentional bias. Eye tracking technology, which allows relatively direct and continuous measurement of overt visual attention, may provide an important supplement to RT measures. This article reviews eye tracking research on anxiety and depression, evaluating the experimental paradigms and eye movement indicators used to study attentional biases. Also included is a meta-analysis of extant eye tracking research (33 experiments; N = 1579) on both anxiety and depression. Relative to controls, anxious individuals showed increased vigilance for threat during free viewing and visual search, and showed difficulty disengaging from threat in visual search tasks, but not during free viewing. In contrast, depressed individuals were not characterized by vigilance for threat during free viewing, but were characterized by reduced orienting to positive stimuli, as well as reduced maintenance of gaze on positive stimuli and increased maintenance of gaze on dysphoric stimuli. Implications of these findings for theoretical accounts of attentional bias in anxiety and depression are discussed, and avenues for future research using eye-tracking technology are outlined.     

Evaluative conditioning of fear and disgust in blood-injection-injury phobia: specificity and impact of individual differences in disgust sensitivity

The present study examines whether the repeated pairing of neutral facial expressions with phobic-relevant stimuli differentially influences evaluative ratings of fear and disgust between analogue blood-injection-injury (BII) phobic (n=40) and non-phobic (n=40) participants. Consistent with prior research, BII phobics reported greater disgust sensitivity than non-phobic participants even after controlling for between group differences in anxiety symptoms. Results from the evaluative conditioning experiment indicated that pre- to posttest increases in fear ratings were only marginally greater for phobic compared to non-phobic participants. However, increases in disgust from pre- to posttest were greater for phobic compared to non-phobic participants and greater for neutral expressions that were paired with threat-relevant stimuli compared to stimuli not paired with threat-relevant stimuli. Subsequent analysis also indicated that pre- to posttest increases in disgust ratings of neutral expressions that were paired with threat-relevant stimuli was moderated by disgust sensitivity levels among phobic and non-phobic participants. Heightened fear and disgust ratings were subsequently reduced by an extinction procedure. Implications of present findings in understanding the role of fear and disgust in BII phobia are discussed.     

Anxiety sensitivity and CO2 challenge anxiety during recovery: differential correspondence of arousal and perceived control

The relations between changes in arousal and perceived control with changes in anxiety-related distress during a 10-min recovery period after exposure to 10% CO(2)-enriched air was examined among community participants (N=47) high (n=23) and low (n=24) in anxiety sensitivity (AS). Rate of decline in arousal was significantly positively associated with rate of decline in anxiety among high and low AS participants when controlling for valence. Rate of increase in perceived control was significantly negatively related to rate of decline in anxiety in the high AS group but not in the low AS group when controlling for valence. These findings suggest that associations between arousal, perceived control, and anxiety-related recovery from a panic-relevant episode of abrupt increases in bodily arousal differ as a function of pre-existing fears of anxiety-related symptoms (i.e., AS). Implications of these findings for disorders associated with elevated AS are discussed.     

Interpretation biases in victims and non-victims of interpersonal trauma and their relation to symptom development

Previous studies examining information processing in posttraumatic stress disorder (PTSD) have focused on attention and memory biases, with few studies examining interpretive biases. The majority of these studies have employed lexically based methodologies, rather than examining the processing of visual information. In the present study, victims (N=40) and non-victims (N=41) of interpersonal trauma viewed a series of short positive, neutral, and threatening filmstrips of social situations with ambiguous endings. Participants were then asked about their perceptions and interpretations of the situations. Victims perceived threatening situations as more predictable and more quickly increasing in risk than non-victims. Trauma status interacted with the perceived predictability of positive situations and the perceived speed with which neutral situations reached their conclusion to predict anxious symptoms. In addition, trauma status interacted with the perceived increase in risk of positive situations to predict PTSD symptoms. The implications of these findings for theories of PTSD are discussed.     

Cognitive vulnerabilities to the development of PTSD: A review of four vulnerabilities and the proposal of an integrative vulnerability model

While some individuals develop PTSD subsequent to traumatic experiences, many individuals resume prior functioning naturally. Diathesis-stress models suggest that stable individual differences present in individuals prior to trauma may serve as vulnerability factors to symptom development. The high levels of comorbidity and symptom similarity suggest that established vulnerability factors for anxiety and depression may also serve as vulnerability factors for PTSD. The examination of multiple vulnerability factors simultaneously may increase understanding of the etiology of PTSD and comorbid post-trauma symptomatology and account for a greater percentage of variance in PTSD symptoms. In addition, the vulnerability factors may be related to distinct sets of symptoms, with vulnerabilities predicting the PTSD symptoms most similar to their associated disorders. Research examining the relations between attributional style, rumination, anxiety sensitivity, and the looming cognitive style and the development of PTSD after trauma exposure is reviewed and suggestions for future research are provided.     

Examination of the decline in symptoms of anxiety and depression in generalized anxiety disorder: impact of anxiety sensitivity on response to pharmacotherapy

Pharmacotherapy is an effective treatment for generalized anxiety disorder (GAD), but few studies have examined the nature of decline of anxiety and depression during pharmacotherapy for GAD and even fewer studies have examined predictors of symptom decline. This study examined the decline in symptoms of anxiety and depression in patients with GAD during a 6-week open trial of fluoxetine. Growth curve analyses indicated that pharmacotherapy with fluoxetine led to significant declines in symptoms of anxiety and depression over the 6 weeks of treatment. However, the decay slope observed for anxiety symptoms was significantly greater than that for depressive symptoms. Further analyses revealed that the decline in anxiety remained significant after accounting for the changes in symptoms of depression. However, the effect of treatment on depression was no longer significant after controlling for the reduction in anxiety symptoms. Overall anxiety sensitivity (AS) did not moderate the level of reduction in symptoms of anxiety or depression during pharmacotherapy. However, AS specific to physical concerns demonstated a marginal negative association with decline in anxiety and depression. AS specific to social concerns also demonstrated a marginal negative association with decline in anxiety symptoms. These findings suggest that the decline in anxiety symptoms is independent of the decline in symptoms of depression during pharmacotherapy for GAD and specific AS dimensions may predict symptom change in GAD.