Impact of psychiatric illness upon asthma patients’ health care utilization and illness control. Are all psychiatric comorbidities created equal?

The impact of psychiatric illnesses upon asthma patients' functioning is not well understood. This study examined the impact of psychiatric comorbidity upon illness management in asthma patients using empirically-derived psychiatric comorbidity groups. Participants were a clinic sample of Greek-speaking asthma patients (N = 212) assessed using the Patient Health Questionnaire (PHQ) Somatoform, Depression, Panic Disorder (PD), Other Anxiety Disorder, Eating Disorder (ED) and Alcohol sub-scales. The associations between sub-scales were examined using multiway frequency analysis. The following groups were derived: Somatoform disorder and/or Any Depressive disorder (n = 63), Somatoform disorder and/or Other Anxiety disorder (n = 51), Somatoform disorder and/or Any ED (n = 60), and Any Anxiety group including PD and/or Other Anxiety disorder (n = 24). Across all groups, psychiatric illness was associated with significantly worse asthma control (p < .01). Participants in Any Anxiety group, OR = 4.61, 95% CI [1.90, 11.15], Somatoform and/or Any Depressive disorder, OR = 2.06, 95% CI [1.04, 4.09] and Somatoform and/or Other Anxiety disorder, OR = 2.75, 95% CI [1.35, 5.60] were at higher risk for asthma-related Emergency Room (ER) visits compared to controls. However only Somatoform and/or Any Depressive disorder, OR = 3.67, 95% CI [1.60, 8.72], Somatoform and/or Other Anxiety disorder, OR = 5.50, 95% CI [2.34, 12.74], and Somatoform and/or Any ED, OR = 4.98, 95% CI [2.14, 11.60] group membership were risk factors for asthma-related hospitalizations. Results suggest that while comorbid psychiatric disorders generally negatively impact asthma illness management, different psychiatric comorbidities appear to have disparate effects upon illness management outcomes.     

Allergic disorders and attention deficit disorder in children

It has been suggested that children with attention deficit disorder-hyperactivity (ADDH) are likely to show allergic disorders, and that both ADDH and allergic disorders may share a common biological background. In a large sample of children from the general population we found no association between parent, teacher, and self-reports of ADDH behaviors and a history of allergic disorders (asthma, eczema, rhinitis, and urticaria) at ages 9 or 13 years. Similarly, reports of ADDH behaviors at age 13 years were not related to level of atopic responsiveness by skin test or serum IgE levels. Our findings call into question the hypothesis that there is a relationship between ADDH and allergic disorder.The Dunedin Multidisciplinary Health and Development Research Unit is supported by the Health Research Council of New Zealand, and involves several departments of the University of Otago. The authors are indebted to the many people whose contributions made this study possible, and in particular the members of the sample and their parents.     

Differences in panic psychopathology between smokers with and without asthma

Cigarette smoking is more common among individuals with asthma compared to those without, resulting in increased risk of morbidity and mortality. However, there has been little exploration of psychological factors that differ between smokers with and without asthma. Thus, the aim of the current study was to examine differences between smokers with and without asthma in terms of anxiety sensitivity, panic symptoms, lifetime history of panic attacks, and lifetime history of panic disorder. Participants were 115 smokers with asthma (55.3% male, M_age = 38.4 years, SD = 11.9) and 120 smokers without asthma (70.6% male, M_age = 37.0 years, SD = 12.8) who were administered a structured diagnostic interview and completed self-report measures. As hypothesized, after controlling for the effects of cigarettes per day, gender, race, and education, smokers with asthma reported higher levels of anxiety sensitivity and panic symptoms and were at an increased risk for having a lifetime history of panic attacks (OR = 3.01) and panic disorder (OR = 2.96) compared to smokers without asthma. Further, group differences in anxiety sensitivity and panic symptoms remained even after removing participants with a lifetime history of panic attacks or panic disorder. These findings suggest that smokers with asthma are a particularly ‘at-risk’ population for panic psychopathology and likely in need of specialized smoking-related prevention and intervention efforts.     

特应性皮炎与过敏进程

过敏性疾病已成为备受关注的社会问题,包括特应性皮炎、食物过敏、过敏性鼻炎、过敏性哮喘等,其发生和发展一直是学术界和社会公众高度关注的话题。变态反应症状可表现在皮肤、胃肠道、鼻腔、支气管等不同部位,流行病学研究发现各类过敏性疾病的出现呈现从儿童湿疹、食物过敏逐渐向过敏性鼻炎、过敏性哮喘发展的过程,婴儿或儿童早期出现的伴高IgE的特应性皮炎往往预示着未来会发生其他过敏性疾病,这种现象被称为变态反应性疾病的自然进程又称过敏进程,即“AllergyMarch”。本文就特应性皮炎与过敏进程的相关研究进行回顾与讨论,以期引起社会各界对特应性皮炎的重视。     

Life events and functional somatic symptoms: A population study in older adolescents

The purpose of this study was to investigate the effect of negative life events on functional somatic symptoms (FSSs) in adolescents, based on data from 957 participants of the population cohort TRacking Adolescents’ Individual Lives Survey. Life events experienced between age 16 and age 19 were assessed with the Kendler's Life Stress interview. FSSs at age 19 and age 16 were measured with the Youth and Adult Self‐Report. The hypotheses were tested by the use of a latent change model. Life events predicted FSSs, even when adjusted for pre‐event levels of FSSs, symptoms of anxiety and depression, and socio‐economic status (B = 0.006, 95% CI [0.003, 0.008], β = .32). Whereas illness‐related life events did not predict FSSs independently (B = −0.003, 95% CI [−0.005, 0.09], β = .05), non‐illness‐related life events did (B = 0.007, 95% CI [0.004, 0.010], β = .31). A past‐year diagnosis of anxiety and/or depression had a significant influence on the association between life events and FSSs (B = 0.37, 95% CI [0.30, 0.46], β = .71), while female sex, exposure to childhood adversities, and family malfunctioning had not. In conclusion, our findings show that FSSs are associated with negative life events in older adolescents. We did not find evidence for stronger effects of illness‐related events.     

Examining the Panic Attack Specifier in Social Anxiety Disorder

Panic attacks (PAs) are characterized by overwhelming surges of fear and discomfort and are one of the most frequently occurring symptoms in psychiatric populations. The most recent version of the Diagnostic and Statistical Manual of Mental Disorders (i.e. DSM-5) allows for a panic attack (PA) specifier for all disorders, including social anxiety disorder (SAD). However, there is little research examining differences between individuals diagnosed with SAD with the PA specifier versus individuals diagnosed with SAD without the PA specifier. The current study examined social anxiety, mood, anxiety, and anxiety sensitivity social concerns, a risk factor for social anxiety in SAD-diagnosed individuals without (N = 52) and with (N = 14) the PA specifier. The groups differed only in somatic symptoms of anxiety. Result of the current study provides preliminary evidence that the presence of the PA specifier in social anxiety does not result in elevated levels of comorbidity or a more severe presentation of social anxiety.     

过敏性鼻炎和支气管哮喘治疗的统一性与整体观

过敏性鼻炎和支气管哮喘是常见的上下气道联合炎性疾病。尽管其治疗手段多样,效果良好,但由于目前对过敏性鼻炎的认识及重视程度不够,治疗现状并不乐观。从哲学上辩证统一的认识过敏性鼻炎和支气管哮喘的治疗,并以现代整体医学的观点分析两者的同一性,为临床实践中针对两者进行整体治疗提供理论依据。     

Evaluating the role of anxiety sensitivity in barriers to cessation and reasons for quitting among smokers with asthma

The aim of the present study was to examine the unique predictive ability of anxiety sensitivity (AS) in terms of perceived barriers to cessation and smoking cessation motives among daily smokers with asthma (n = 125, 54% male, M_age = 37.7 years, SD = 12.1). As hypothesized, after controlling for the effects of race, asthma control, negative affect, and smoking rate, AS significantly predicted greater barriers to cessation, and reasons for quitting related to health concerns and self-control. Contrary to hypotheses, AS did not significantly predict external reasons for quitting. These findings suggest that smokers with asthma who are fearful of physiological arousal may be a particularly ‘at-risk’ population for smoking cessation difficulties due, in part, to greater perceived barriers to cessation. Interventions focused on enhancing intrinsic motivation for quitting and reducing AS may be most effective for this population.     

The role of maladaptive anger in self-criticism: A quasi-experimental study on emotional processes

The present study examines the role of emotion in the self-critical process of individuals with anger problems. Self-criticism is a prevalent intra-personal feature which greatly impacts an individual’s emotion. So far, it is unclear, which emotions individuals with maladaptive anger experience when they work through their self-criticism. Using a quasi-experimental design, the present study compared n = 23 anger-prone under-graduate students to n = 22 controls on process indices of contempt, fear, shame, anger and global distress, as well as on their access to underlying need, as participants were working through personalized self-critical content. This was achieved using a single-session enactment from emotion-focused therapy, augmented with a standardized procedure for priming participants to focus on their unmet needs. Findings suggested that this work on self-criticism reduced for both groups distress, fear and shame, as well as increased assertive anger (McNemar tests significant at p = .05). More centrally, anger-prone individuals expressed more self-contempt (t(1, 44) = 3.65; p < .05), and they had more difficulty in accessing their underlying need (χ² = 5.35; p < .05), when compared to controls. These results have implications for clinical work with anger-prone individuals, and clarify key features in the use of enactment interventions when working towards emotional resolution. The present study also demonstrates the use of personalized stimuli in the context of clinically relevant quasi-experimental research on emotional processes.     

Body Mass Index and functional impairment: the explanatory role of anxiety sensitivity among treatment-seeking smokers

Obesity and smoking are highly prevalent public health concerns in the United States. Data indicate that elevated Body Mass Index (BMI) is related to functional impairment. However, there is limited understanding of mechanisms that may explain their comorbidity among smokers. The current study sought to test whether anxiety sensitivity explained the relation between BMI and functional impairment among 420 (46.9% females; M_age = 38 years, SD = 13.42) treatment-seeking, adult smokers. Results indicated that BMI yielded a significant indirect effect through anxiety sensitivity for functional impairment, b = 0.01, SE = .01, 95% CI = [.002, .021]. These findings remained significant after controlling for participant sex, negative affectivity, tobacco dependence, psychopathology, and medical conditions (i.e. hypertension, heart problems, respiratory disease, asthma). Such data provide novel empirical evidence that, among smokers, BMI may be a risk factor for functional impairment indirectly through anxiety sensitivity. Overall, such findings could potentially inform the development of personalized interventions among this particularly vulnerable segment of the smoking population.     

Asthma in children of Caribbean descent living in the inner-city: comparing Puerto Rican and Afro-Caribbean children

Ethnic minority children bear a disproportionate amount of the US asthma burden. We compared asthma morbidity and pulmonary function (%FEV₁) in two Caribbean groups living in the Bronx, NY: Puerto Rican and Afro-Caribbean children. Caregiver-child dyads (Puerto Rican: n = 113, M age = 9.89 ± 2.05; Afro-Caribbean: n = 47, Mage = 10.35 ± 2.08) responded to sociodemographic and asthma-related questions, and children’s %FEV₁ was measured. Puerto Rican children had significantly greater (past year) asthma morbidity, yet there were no significant differences in %FEV₁. This discrepancy between objective pulmonary function and asthma morbidity suggests the importance of considering sociocultural factors in pediatric asthma care.     

Reducing contingent self-worth: A defensive response to self-threats

Previous research shows that people with high self-esteem cope with threats to the self by reducing the extent to which their self-worth is contingent on the threatened domain (Buckingham, Weber, & Sypher, 2012). The present studies tested the hypothesis that this is a defensive process. In support of this hypothesis, Study 1 (N = 160), showed that self-affirmation attenuates the tendency for people with high self-esteem to reduce their contingencies of self-worth following self-threat. Furthermore, Study 2 (N = 286), showed that this tendency was more prevalent among people with defensive self-esteem than among those with secure self-esteem. The present studies imply that reducing contingent self-worth after self-threat is a defensive process. We discuss implications for theories of contingent self-worth.     

Psychiatric Comorbidity in Children with Autism Spectrum Disorders: A Comparison with Children with ADHD

The present study was conducted with the aim to identify comorbid psychiatric disorders in children with autism spectrum disorders (ASD) (n = 40) and to compare those comorbidity rates to those in children with attention deficit hyperactivity disorder (ADHD) (n = 40). Participants were clinically referred children aged 7–18 years. DSM-IV classifications were used for the primary diagnosis (ASD/ADHD), while comorbid psychiatric disorders were assessed using a structured diagnostic interview, the structured clinical interview for DSM-IV, childhood diagnoses (KID-SCID). Twenty-three children with ASD (57.5 %) had at least one comorbid disorder, whereas 16 children with ADHD (40.0 %) were classified as having at least one comorbid disorder. No group differences were found with respect to this comorbidity rate or for the rate of comorbid externalizing disorders (ODD and/or CD). However, children with ASD had more comorbid internalizing disorders compared to children with ADHD. More specifically, children with ASD had higher rates of anxiety disorders, but not mood disorders. No associations between comorbidity and age or between comorbidity and the intelligence quotient was found. It is important for clinicians to always be aware of, and screen for, comorbidity, and to consider treatment for these comorbid disorders. In addition, research should focus on establishing valid and reliable screening tools as well as effective treatment options for these comorbid disorders.     

Cognitive empathy moderates the relationship between affective empathy and wellbeing in adolescents with autism spectrum disorder

Background: Individuals with autism spectrum disorder (ASD) reportedly have reduced cognitive empathy (CE), yet intact levels of affective empathy (AE) when compared to typically developing individuals. To date, no research has examined the implications of this empathic imbalance on personal wellbeing (PWB). Method: Twenty four high-functioning adolescents with ASD (M _age = 13.21, SD = 2.83, 14 males) and 24 non-clinical control adolescents (M _age = 13.10, SD = 2.73, 15 males) took part in the present study. CE and AE were measured using the interpersonal reactivity index, while PWB was assessed via the personal wellbeing index-school children. Results: Participants in the ASD group scored significantly lower than the control group on measures of CE and AE. Moderated regression analyses revealed that for the ASD group only, CE appeared to moderate the relationship between AE and PWB. Specifically, when CE was low, the relationship between AE and PWB was significant and negative. However, when CE was high, the relationship between AE and PWB was significant and positive. Conclusions: CE appears central to the PWB of those with ASD. Only when CE is high were participants able to experience the positive relationship between AE and PWB. Interventions that target the cognitive dimensions of empathy may improve PWB.     

Drinking Motives as Mediators of Social Anxiety and Hazardous Drinking Among College Students

Although social anxiety (SA) and alcohol use disorders commonly co-occur, the relationship between these variables in college populations has been inconsistent. The present study tested the hypothesized model that negatively reinforcing, but not positively reinforcing, drinking motives (or reasons for drinking) would mediate the association between SA and three aspects of hazardous drinking (quantity/frequency, consequences, and dependence symptoms) in an ethnically diverse sample of college drinkers (N = 817; mean age = 19.9 years, range = 18–29). Structural equation modeling (SEM) results using the asymmetrical distribution of products test indicated that coping motives partially mediated the relationship between SA and negative consequences and dependence symptoms but not the quantity/frequency outcome. Contrary to the hypothesized model, conformity motives did not mediate the association between SA and hazardous drinking. As expected, positive reinforcement motives did not mediate the SA–hazardous drinking association. Multigroup SEM analyses revealed that the mediation models did not differ for men (n = 215) and women (n = 602). Overall, the present findings support extant research and theoretical models regarding the mediating role of coping motives in the relationship between SA and problem drinking, suggesting a potential pathway for the development and maintenance of SA and alcohol use disorder comorbidity. Such findings could contribute to improved intervention programs by targeting coping drinking motives and building coping skills.     

Spatial navigation deficits in amnestic mild cognitive impairment with neuropsychiatric comorbidity

Aims: To find out whether neuropsychiatric comorbidity (comMCI) influences spatial navigation performance in amnestic mild cognitive impairment (aMCI).

Methods: We recruited aMCI patients with (n = 21) and without (n = 21) neuropsychiatric comorbidity or alcohol abuse, matched for global cognitive impairment and cognitively healthy elderly participants (HE, n = 22). They completed the Mini-Mental State Examination and a virtual Hidden Goal Task in egocentric, allocentric, and delayed recall subtests.

Results: In allocentric navigation, aMCI and comMCI performed significantly worse than HE and similarly to each other. Although aMCI performed significantly worse at egocentric navigation than HE, they performed significantly better than patients with comMCI.

Conclusions: Despite the growing burden of dementia and the prevalence of neuropsychiatric symptoms in the elderly population, comMCI remains under-studied. Since trials often assess “pure” aMCI, we may underestimate patients’ navigation and other deficits. This finding emphasizes the importance of taking account of the cognitive effects of psychiatric disorders in aMCI.     

Ethnic Speech and Ethnic Action as Ethnic Behavior: Part 1. Construction of the Brunel Ethnic Behavior Inventory

This article reports the construction of a new survey—specifically, the Brunel Ethnic Behavior Inventory (BEBI)—designed to measure ethnic speech and ethnic action as separate, yet related, aspects of individuals’ ethnic behavior. Using Tajfel’s social identity theory as a conceptual frame of reference, this study sought an answer to the research question of how many factors actually are measured by the BEBI, and tested the hypothesis that a two-factor model (i.e., Ethnic Speech and Ethnic Action as two correlated factors) would provide significantly better goodness of fit to the correlational data than would a one-factor model (i.e., Ethnic Behavior as one undifferentiated factor). Across one pilot sample (n = 101) and two main samples (n = 120 for Sample 1, n = 148 for Sample 2), the study found that not only did the BEBI measure two factors at most (i.e., Ethnic Speech and Ethnic Action) but, consistent with the hypothesis, the two-factor model yielded better goodness of fit than did the one-factor model. Implications for the conceptualization and measurement of Verkuyten’s “ways of ethnicity” are discussed.     

A case-control study of hopelessness and suicidal behavior in the city of Athens,Greece. The role of the financial crisis

This study aimed to examine the psychometric properties of Beck Hopelessness Scale (BHS) in Greek patients with a recent suicide attempt, the predictive ability of BHS especially in terms of age and the possible effect of the financial crisis on hopelessness as it has been identified as a significant suicide risk factor. The study included a total of 510 individuals, citizens of Athens, Greece. Three hundred and forty individuals (170 attempted suicide patients, and 170 -age and gender- matched healthy individuals used as controls) completed BHS before the financial crisis onset (from 2009 to 2010). A sample of 170 healthy individuals also completed the BHS after the financial crisis onset (from 2013 to 2014), when the impact of the austerity measures was being felt by the Greek society. The Greek BHS version demonstrated good psychometric properties and a sufficient degree of internal consistency. Attempted suicide patients (M = 9) presented higher hopelessness than the controls (M = 3). The patients’ age positively correlated with hopelessness (r_s = .35, p < .001), and the ROC curve revealed that the BHS ability to discriminate the individuals with pathological rates of hopelessness from those without, strengthened as age increased. No significant differences were found between the individuals evaluated before (M = 3) and after (M = 3, p > .05) the crisis onset. Nevertheless, regarding the latter group, the women, the younger individuals, the less educated, the unemployed and the participants with low or mediocre self-reported financial status presented increased hopelessness. Our findings suggest that BHS could be a useful instrument especially when screening for suicide risk in people of older age, and that the financial crisis in Greece had a greater impact on subgroups of the population regarding hopelessness.     

Naming speed as a predictive diagnostic measure in reading and attentional problems

This study aimed to describe and compare naming speed abilities in children diagnosed with either Reading Learning Difficulties (RLD) or Attention Deficit/Hyperactivity Disorder (ADHD), or comorbidity for both (ADHD+RLD). To examine the explanatory power of naming speed and ADHD symptomatology in predicting group associations (while controlling for gender and age), the “Rapid Automatized Naming and Rapid Alternating Stimulus Tests” (RAN/RAS) were utilized. A sample of 101 children (age range = 5–16 years) was divided into four groups: RLD (n = 14), ADHD (n = 28), comorbid (n = 19), and control (n = 40). There were statistically significant differences in RAN/RAS results among the diagnostic groups. Moreover, discriminant analysis revealed that naming speed tasks significantly predicted reading and attentional problems, especially at earlier ages. These results demonstrate the potential usefulness of RAN/RAS in the diagnosis of reading and attentional problems, particularly if the children are aged from 5 to 9.     

Physical Attractiveness and Altruism in Two Modified Dictator Games

Several studies find that male individuals are more altruistic toward attractive women, suggesting altruism may serve as a courtship display. Many studies exploring this phenomenon have used vignettes and facial images. We tested the sexual selection hypothesis as an explanation for altruistic behavior, where players played the dictator game with “live” participants. Two studies were conducted (Study 1, n = 212; Study 2, n = 188) where we manipulated stakes and anonymity between participants to explore the relationship between the dictator’s allocations and their perceived attractiveness of the recipient. We found no relationship between attractiveness and altruism. Dictators were consistently fair when allocating stakes, irrespective of the recipients’ attractiveness.