Integrating neurobiology and psychopathology into evidence-based treatment of social anxiety disorder

Social anxiety disorder (SAD) is a common, chronic psychiatric disorder characterized by a persistent fear of social or performance situations in which embarrassment can occur. This disorder typically appears during the mid-adolescent years and is unremitting throughout life if not properly treated. SAD presents as two subtypes: the more common and debilitating generalized form, and the nongeneralized form, which consists predominantly of performance anxiety. The majority of patients with SAD have comorbid mental disorders, including mood, anxiety, and substance abuse. No single development theory has been proposed to account for the origins of SAD, although current understanding of the etiology of SAD posits an interaction between psychological and biological factors. Risk factors include environmental and parenting influences and dysfunctional cognitive and conditioning events in early childhood. The neurobiology of SAD appears to involve neurochemical dysfunction, as evidenced by studies of neuroreceptor imaging, neuroendocrine function, and profiles of response to specific medications. Clinical trials have demonstrated that benzodiazepines and antidepressants are effective in the treatment of SAD. The selective serotonin reuptake inhibitors are emerging as the first-line treatment for SAD, based on their proven safety, tolerability, and efficacy. Goals for ongoing future research include development of approaches to achieve remission, to convert nonresponders and partial responders to full responders, and to prevent relapse and maintain long-term efficacy. This monograph explores the epidemiology, clinical presentation, and differential diagnosis of SAD, with a focus on neural circuitry of social relationships and neurochemical dysfunction. The prevalence, rates of recognition and treatment, patterns of comorbidity, quality-of-life issues, and natural history of SAD are discussed as well as pharmacologic and psychosocial treatment strategies for SAD.     

The paradox of quetiapine in obsessive-compulsive disorder

Schizophrenia and obsessive-compulsive disorder (OCD) have historical, clinical, and epidemiological links. The clinical use of atypical neuroleptics (ie, dual serotonin-dopamine antagonists) to treat both conditions sheds a new light on them. We report the first two cases of obsessive-compulsive symptoms (OCS) induced by quetiapine in schizophrenia patients. A case of successful augmentation by quetiapine in refractory OCD is also presented. A review of the literature on OCS induced by atypical neuroleptics follows. This paradoxically induced OCD symptomology in schizophrenia patients administered atypical neuroleptics is discussed from new pathophysiological and clinical perspectives. The discussion emphasizes the prognostic implications of OCS in schizophrenia and available therapies for this comorbidity.     

Writing brains: tracing the psyche with the graphical method

At the end of the 19th century, the graphic method kindled attempts to use it for investigating psychic processes. In Germany, Hans Berger took up this line of research, later to become the pioneer of electroencephalography (EEG). This trajectory of Berger's work is analyzed as an "enabling constraint" guiding him toward the EEG at a time when nobody else was pursuing this line of research and also causing serious methodological problems. In the epistemological perspective of this analysis, many of his problems extend beyond the local context of his work and point toward ambiguities surrounding the project to trace the psyche with the graphic method. From the mid-1930s, the EEG inspired ongoing attempts to decipher the specific meanings of these recordings, and large ensembles of machinery were mobilized, molding concepts of the psyche according to the results and the specifications of the graphic method.     

Can chimpanzee infants (Pan troglodytes) form categorical representations in the same manner as human infants (Homo sapiens)?

We directly compared chimpanzee infants and human infants for categorical representations of three global-like categories (mammals, furniture and vehicles), using the familiarization-novelty preference technique. Neither species received any training during the experiments. We used the time that participants spent looking at the stimulus object while touching it as a measure. During the familiarization phase, participants were presented with four familiarization objects from one of three categories (e.g. mammals). Then, they were tested with a pair of novel objects, one was a familiar-category object and another was a novel-category object (e.g. vehicle) in the test phase. The chimpanzee infants did not show significant habituation, whereas human infants did. However, most important, both species showed significant novelty-preference in the test phase. This indicates that not only human infants, but also chimpanzee infants formed categorical representations of a global-like level. Implications for the shared origins and species-specificity of categorization abilities, and the cognitive operations underlying categorization, are discussed.     

Semantic feature production norms for a large set of living and nonliving things

Semantic features have provided insight into numerous behavioral phenomena concerning concepts, categorization, and semantic memory in adults, children, and neuropsychological populations. Numerous theories and models in these areas are based on representations and computations involving semantic features. Consequently, empirically derived semantic feature production norms have played, and continue to play, a highly useful role in these domains. This article describes a set of feature norms collected from approximately 725 participants for 541 living (dog) and nonliving (chair) basic-level concepts, the largest such set of norms developed to date. This article describes the norms and numerous statistics associated with them. Our aim is to make these norms available to facilitate other research, while obviating the need to repeat the labor-intensive methods involved in collecting and analyzing such norms. The full set of norms may be downloaded from www.psychonomic.org/archive.     

Behavioral and neural predictors of upcoming decisions

Although it is widely known that brain regions such as the prefrontal cortex, the amygdala, and the ventral striatum play large roles in decision making, their precise contributions remain unclear. Here, we used functional magnetic resonance imaging and principles of reinforcement learning theory to investigate the relationship between current reinforcements and future decisions. In the experiment, subjects chose between high-risk (i.e., low probability of a large monetary reward) and low-risk (high probability of a small reward) decisions. For each subject, we estimated value functions that represented the degree to which reinforcements affected the value of decision options on the subsequent trial. Individual differences in value functions predicted not only trial-to-trial behavioral strategies, such as choosing high-risk decisions following high-risk rewards, but also the relationship between activity in prefrontal and subcortical regions during one trial and the decision made in the subsequent trial. These findings provide a novel link between behavior and neural activity by demonstrating that value functions are manifested both in adjustments in behavioral strategies and in the neural activity that accompanies those adjustments.     

Psychotherapy process: the missing link: comment on Westen, Novotny, and Thompson-Brenner (2004)

In this comment, J. S. Ablon and C. Marci argue that focusing on the empirical validation of manualized treatment packages misses important information about what is efficacious about a given treatment. Psychotherapy process has demonstrated that treatments may promote change in ways other than their underlying theories claim. Manualized therapies may appear distinct despite important similarities in dyadic interaction. These functional similarities in the emergent transactional process between therapist and patient may help explain the difficulty demonstrating differential outcomes across brands of brief therapy. Rather than focus on treatment packages targeting patient symptomatology, the authors recommend a shift in focus to the empirical validation of change processes coconstructed by therapist and patient in naturalistic settings.