Familial comorbidity of bipolar disorder and multiple sclerosis: Genetic susceptibility, coexistence or causal relationship?

Our purpose in undertaking the present study was to examine the hypotheses proposed for explaining the frequent comorbidity of bipolar disorder and multiple sclerosis. One hypothesis posits that, when there is comorbidity, MS plays a causal role in psychiatric manifestations. Another suggests that both disorders have a common underlying physiological process that increases the likelihood of their co-occurrence. We examined two adult siblings with comorbidity and their relatives, including three generations of family members with psychiatric morbidity. We found an extensive multigenerational history of bipolar disorder in this family. This history would seem to support the hypothesis of a common underlying brain process (potentially genetically-based) to explain the comorbidity of BD and MS, but cannot clarify whether this comorbidity implies a relationship between the two disorders or merely reflects parallel processes of brain deterioration. We cannot, however, rule out the possibility of a subclinical MS-related process leading to the early manifestation of BD, with MS appearing much later in time, or even a third, undetermined factor, leading to familial comorbidity. Although we have insufficient information to support either hypothesis definitively, we present the familial cases as a springboard for a discussion of dilemmas related to teasing apart MS and BD comorbidity. Further observation of the clinical course of the younger family members, who have not yet shown any neurological signs, over the next few years may elucidate the current picture further.     

Modes of action of family interventions in depression and schizophrenia: the same or different?

The role of relatives' expressed emotion (EE) in mediating the efficacy of family interventions has been studied in randomized controlled trials (RCTs) involving people with schizophrenia and depression. Reanalysis of two RCTs (n=48) by Leff (1989) indicated that lowering relatives' EE and/or reducing social contact between the patient and family members accounted for the efficacy of the intervention for schizophrenia. However, this relationship has not been investigated previously with regard to depression, and this paper presents the results of a recent RCT which included measurement of EE and other possible mediating variables. In this study, amelioration of the critical attitude of the partner did not account for the superiority of couples therapy over antidepressant medication, since the same change occurred in the drug group. However, reducing the patient's exposure to the partner's hostility partially explained the efficacy of couples therapy. Further research on the process of change in families undergoing therapy is indicated to identify the variables that account for the efficacy of therapy.     

Optimism and pessimism in the context of health: bipolar opposites or separate constructs?

One difficulty plaguing research on dispositional optimism and health is whether optimism and pessimism are bipolar opposites or constitute distinct constructs. The present study examined the Life Orientation Test to determine whether the two-factor structure is explained by method bias (due to measurement) or substantive differences. The authors compared three measurement models: bipolar, bivariate, and method artifact. Optimism and pessimism emerged as distinct constructs due to substantive differences. The authors also considered the validity of optimism and pessimism, examining their relations with psychological and physical health outcomes. Optimism and pessimism were more similar in relation to psychological health than to other health-related behavior or physical health outcomes. However, a strongly interpretable pattern for the relation of optimism and pessimism to the health outcomes did not emerge. Further research may benefit from considering optimism and pessimism as bivariate and also should consider the conceptual components and behavioral mechanisms specific to each variable.     

Repetitive transcranial magnetic stimulation induced slow wave activity modification: A possible role in disorder of consciousness differential diagnosis?

Slow wave activity (SWA) generation depends on cortico–thalamo-cortical loops that are disrupted in patients with chronic Disorders of Consciousness (DOC), including the Unresponsive Wakefulness Syndrome (UWS) and the Minimally Conscious State (MCS). We hypothesized that the modulation of SWA by means of a repetitive transcranial magnetic stimulation (rTMS) could reveal residual patterns of connectivity, thus supporting the DOC clinical differential diagnosis. We enrolled 10 DOC individuals who underwent a 24 hh polysomnography followed by a real or sham 5 Hz-rTMS over left primary motor area, and a second polysomnographic recording. A preserved sleep-wake cycle, a standard temporal progression of sleep stages, and a SWA perturbation were found in all of the MCS patients and in none of the UWS individuals, only following the real-rTMS. In conclusion, our combined approach may improve the differential diagnosis between MCS patients, who show a partial preservation of cortical plasticity, and UWS individuals, who lack such properties.     

The anxiety disorder spectrum: Fear imagery,physiological reactivity,and differential diagnosis∗

Abstract

This review considers recent research assessing psychophysiological reactivity to fear imagery in anxiety disorder patients. As in animal subjects, fear cues prompt in humans a state of defensive motivation in which autonomic and somatic survival reflexes are markedly enhanced. Thus, a startle stimulus presented in a fear context yields a stronger (potentiated) reflex, providing a quantitative measure of fearful arousal. This fear potentiation is further exaggerated in specific or social phobia individuals when viewing pictures or imagining the phobic object. Paradoxically, fear imagery studies with more severe anxiety disorder patients – panic disorder with agoraphobia, generalized anxiety disorder, or anxious patients with comorbid depression – show a blunted, less robust fear potentiated response. Furthermore, this reflex blunting appears to systematically be more pronounced over the anxiety disorder spectrum, coincident with lengthier chronicity, worsening clinician-based judgments of severity and prognosis, and increased questionnaire-based indices of negative affectivity, suggesting that normal defensive reactivity may be compromised by an experience of long-term stress.     

Spatial frequency processing in schizophrenia: trait or state marker?

B. F. O'Donnell et al. found impaired discrimination performances at low and medium spatial frequencies in patients with schizophrenia. In this study, the authors replicated this finding in a group of remitted, unmedicated, and highly functioning outpatients with spared IQ and attentional functions. However, the deficit was restricted to low spatial frequencies (0.5 cycles/degree), which suggests that this deficit is a trait marker of schizophrenia.     

Reduced or increased influence of non-pertinent information in patients with schizophrenia?

We tested the ability of 18 patients with schizophrenia and 18 matched controls to filter non-pertinent information in orientation matching tasks. The non-pertinent information consisted of pictures conveying semantic information. The pertinent information consisted of oriented line-segments drawn inside pictures or was represented by the overall orientation of the picture itself. The results showed that non-pertinent information interfered with performance of control subjects in all tasks. In contrast, non-pertinent information interfered with the performance of patients with schizophrenia to the same extent as that of matched controls only when non-pertinent and pertinent information was physically mingled, but not when they were separated. Yet, patients processed non-pertinent information in all experiments, as shown by reversed interference effects when non-pertinent and pertinent information was physically separated. These results suggest a deficit at linking physically distinct visual information in patients with schizophrenia. Additionally, performance was more impaired in patients with schizophrenia than in control subjects when the amount of displayed information increased. The results suggest the coexistence, and a possible relationship between attentional deficits and impairments at linking distinct visual information in patients with schizophrenia.     

Failures of cognitive control or attention? The case of stop-signal deficits in schizophrenia

We used Bayesian cognitive modelling to identify the underlying causes of apparent inhibitory deficits in the stop-signal paradigm. The analysis was applied to stop-signal data reported by Badcock et al. (Psychological Medicine 32: 87-297, 2002) and Hughes et al. (Biological Psychology 89: 220-231, 2012), where schizophrenia patients and control participants made rapid choice responses, but on some trials were signalled to stop their ongoing response. Previous research has assumed an inhibitory deficit in schizophrenia, because estimates of the mean time taken to react to the stop signal are longer in patients than controls. We showed that these longer estimates are partly due to failing to react to the stop signal (“trigger failures”) and partly due to a slower initiation of inhibition, implicating a failure of attention rather than a deficit in the inhibitory process itself. Correlations between the probability of trigger failures and event-related potentials reported by Hughes et al. are interpreted as supporting the attentional account of inhibitory deficits. Our results, and those of Matzke et al. (2016), who report that controls also display a substantial although lower trigger-failure rate, indicate that attentional factors need to be taken into account when interpreting results from the stop-signal paradigm.     

Switching, induction of rapid cycling, and increased suicidality with antidepressants in bipolar patients: fact or overinterpretation?

Antidepressants constitute a central cornerstone in the treatment of depressive syndromes. In bipolar patients, however, there is an ongoing controversy about their usefulness for at least 3 decades. Early reports, mainly concerning tricyclic antidepressants, have repeatedly pointed toward unfavorable side effects on the course of the disorder, namely switching into (hypo)mania, induction of rapid cycling, and increased risk of suicide. Most evidence for both unfavorable and favorable effects has been deducted, thus far, from small studies with methodological flaws. More substantiated evidence only recently became available. From this it appears that, at least, the switch risk, and perhaps also the risk for rapid cycling and new-onset suicidality have been overinterpreted. At the same time, these new data raise doubt about the efficacy of antidepressants as a primary-treatment choice in bipolar depression.     

People--things and data--ideas: bipolar dimensions?

We examined a longstanding assumption in vocational psychology that people-things and data-ideas are bipolar dimensions. Two minimal criteria for bipolarity were proposed and examined across 3 studies: (a) The correlation between opposite interest types should be negative; (b) after correcting for systematic responding, the correlation should be greater than -.40. In Study 1, a meta-analysis using 26 interest inventories with a sample size of 1,008,253 participants showed that meta-analytic correlations between opposite RIASEC (realistic, investigative, artistic, social, enterprising, conventional) types ranged from -.03 to .18 (corrected meta-analytic correlations ranged from -.23 to -.06). In Study 2, structural equation models (SEMs) were fit to the Interest Finder (IF; Wall, Wise, & Baker, 1996) and the Interest Profiler (IP; Rounds, Smith, Hubert, Lewis, & Rivkin, 1999) with sample sizes of 13,939 and 1,061, respectively. The correlations of opposite RIASEC types were positive, ranging from .17 to .53. No corrected correlation met the criterion of -.40 except for investigative-enterprising (r = -.67). Nevertheless, a direct estimate of the correlation between data-ideas end poles using targeted factor rotation did not reveal bipolarity. Furthermore, bipolar SEMs fit substantially worse than a multiple-factor representation of vocational interests. In Study 3, a two-way clustering solution on IF and IP respondents and items revealed a substantial number of individuals with interests in both people and things. We discuss key theoretical, methodological, and practical implications such as the structure of vocational interests, interpretation and scoring of interest measures for career counseling, and expert RIASEC ratings of occupations.     

Histrionic personality disorder and antisocial personality disorder: sex-differentiated manifestations of psychopathy?

Little is known about the etiology of histrionic personality disorder (HPD) or its relation to other personality disorders. In this study, we examined whether HPD is etiologically related to psychopathy and more specifically whether HPD and antisocial personality disorder (ASPD) are sex-typed alternative manifestations of psychopathy. In addition, based on Newman's (1987) response modulation hypothesis of psychopathy, we examined the associations between psychopathic, HPD, and ASPD features and performance on laboratory measures of passive avoidance errors and interference effects. Seventy-five live theater actors completed self-report questionnaires and two laboratory measures of response modulation, and peers completed questionnaires concerning the participants' personality disorder features. The results provided weak and inconsistent support for the hypotheses that HPD is a female-typed variant of psychopathy and that ASPD is a male-typed variant of psychopathy. Contrary to previous findings, scores on response modulation tasks were not significantly related to psychopathy, or to either HPD or ASPD. The limitations of this study and possibilities for future research in this area are outlined.     

Gender differences in empathic accuracy: Differential ability or differential motivation?

Following their qualitative review of the findings from 10 relevant studies, Graham and Ickes (1997) speculated that reliable gender‐of‐perceiver differences in empathic accuracy (a) were limited to studies in which the empathic inference form made empathic accuracy salient as the dimension of interest, and (b) therefore reflected the differential motivation, rather than the differential ability, of female versus male perceivers. These speculations were tested more rigorously in the present study, which examined a larger set of 15 empathic accuracy studies and applied the techniques of quantitative meta‐analysis to test Graham and Ickes’(1997) moderating variable hypothesis. The hypothesis was strongly supported, consistent with a motivational interpretation previously proposed by Berman (1980) and by Eisenberg and Lemon (1983), which argues that reliable gender differences in empathy‐related measures are found only in situations in which (a) subjects are aware that they are being evaluated on an empathy‐relevant dimension, and/or (b) empathy‐relevant gender‐role expectations or obligations are made salient.     

Auditory agnosia: apperceptive or associative disorder?

Neuropsychological testing of a patient with auditory agnosia showed that certain difficulties in the initial analysis of sounds may be the cause of his inability to understand spoken words and other sounds. Abnormalities included a slow reaction time to brief auditory stimuli (but not to equally brief visual stimuli or to longer auditory stimuli) and the need for approximately 1/4 sec of silence between two tones before the patient was able to hear them as separate. He could identify words and word associations if he was able to view the object whose name or word associate he was hearing. The findings imply that this patient's deficit in comprehending speech was probably apperceptive rather than associative in origin.     

Order or disorder? Impaired Hebb learning in dyslexia

The present study offers an integrative account proposing that dyslexia and its various associated cognitive impairments reflect an underlying deficit in the long-term learning of serial-order information, here operationalized as Hebb repetition learning. In nondyslexic individuals, improved immediate serial recall is typically observed when one particular sequence of items is repeated across an experimental session, a phenomenon known as the Hebb repetition effect. Starting from the critical observation that individuals with dyslexia seem to be selectively impaired in cognitive tasks that involve processing of serial order, the present study is the first to test and confirm the hypothesis that the Hebb repetition effect is affected in dyslexia, even for nonverbal modalities. We present a theoretical framework in which the Hebb repetition effect is assumed to be a laboratory analogue of naturalistic word learning, on the basis of which we argue that dyslexia is characterized by an impairment of serial-order learning that affects language learning and processing.     

Cognitive behavioral therapy for panic disorder and comorbidity: more of the same or less of more?

This study compared the effects of a higher dose of cognitive behavioral therapy (CBT) for panic disorder versus CBT for panic disorder combined with "straying" to CBT for comorbid disorders in individuals with a principal diagnosis of panic disorder with or without agoraphobia. Sixty-five participants were randomly assigned to one of two treatment conditions, either CBT focused solely upon panic disorder and agoraphobia or CBT that simultaneously addressed panic disorder and agoraphobia and, to a lesser degree, the most severe comorbid condition. Results indicated a significant reduction in panic disorder severity and a decline in severity of comorbid diagnoses across both treatment conditions. However, individuals receiving CBT focused only on panic disorder were more likely to meet high end-state functioning at post-treatment, even in intent-to-treat analyses, and report zero panic attacks at the 1-year follow-up, although this effect was not retained in intent-to-treat analyses. At follow-up, CBT focused only on panic disorder yielded more substantial improvement in the most severe baseline comorbid condition, although not in intent-to-treat analyses, and a greater proportion of individuals in this treatment condition were rated as having no comorbid diagnoses, even in intent-to-treat analyses. These findings raise the possibility that remaining focused on CBT for panic disorder may be more beneficial for both principal and comorbid diagnoses than combining CBT for panic disorder with 'straying' to CBT for comorbid disorders.     

Distinguishing common and task-specific processes in word identification: a matter of some moment?

The same 500 words were presented in 6 different word identification tasks (Experiment 1: lexical decision, semantic categorization, and 3 speeded naming tasks; Experiment 2: delayed naming). Reaction time (RT) distributions were estimated for each task and analyses tested for the effects of word frequency and animacy on various parameters of the RT distribution. Low frequency words yielded more skewed distributions than high frequency words in all tasks except delayed naming. The differential skew was most marked for tasks that required lexical discrimination. The semantic categorization task yielded highly skewed distributions for all words, but the word frequency effect was due to shifts in the location of the RT distributions rather than changes in skew. The results are used to evaluate the relative contributions of a common lexical access process and task-specific processes to performance in lexical discrimination and naming tasks.     

Sex differences in regret: all for love or some for lust?

Few sex differences in regret or counterfactual thinking are evident in past research. The authors discovered a sex difference in regret that is both domain-specific (i.e., unique to romantic relationships) and interpretable within a convergence of theories of evolution and regulatory focus. Three studies showed that within romantic relationships, men emphasize regrets of inaction over action (which correspond to promotion vs. prevention goals, respectively), whereas women report regrets of inaction and action with equivalent frequency. Sex differences were not evident in other interpersonal regrets (friendship, parental, sibling interactions) and were not moderated by relationship status. Although the sex difference was evident in regrets centering on both sexual and nonsexual relationship aspects, it was substantially larger for sexual regrets. These findings underscore the utility of applying an evolutionary perspective to better understand goal-regulating, cognitive processes.