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 influence of NMDA receptors in the dorsomedial striatum on response reversal learning

In mammals, the dorsomedial striatum is one brain area shown to be critical for the flexible shifting of response patterns. At present, the neurochemical mechanisms that underlie learning during a shift in response patterns are unknown. The present study examined the effects of NMDA competitive antagonist, DL-2-amino-5-phosphonopentanoic acid (AP-5), injected into the dorsomedial striatum on the acquisition and reversal of a response discrimination. Male Long-Evans rats were tested across two consecutive days in a modified cross-maze. Rats received an infusion of either saline or AP-5 (5 or 25 nmol) 5 min prior to each test session. In the acquisition phase rats learned to turn in one direction (right or left) to receive a cereal reinforcement. In the reversal learning phase rats learned to turn in the opposite direction as in the acquisition phase. In both phases, criterion was achieved when a rat made 10 consecutive correct trials. Infusions of AP-5 did not impair acquisition, but impaired reversal learning of a response discrimination in a dose-dependent fashion. The reversal learning deficit induced by AP-5 resulted from reversions back to the originally learned response pattern following the initial shift. These results suggest that activation of NMDA receptors in the dorsomedial striatum are critical for the flexible shifting of response patterns by enhancing the reliable execution of a new response pattern under changing task contingencies.     

Associations in the course of personality disorders and Axis I disorders over time

In this study, the authors examined time-varying associations between schizotypal (STPD), borderline (BPD), avoidant (AVPD), or obsessive-compulsive (OCPD) personality disorders and co-occurring Axis I disorders in 544 adult participants from the Collaborative Longitudinal Personality Disorders Study. The authors tested predictions of specific longitudinal associations derived from a model of crosscutting psychobiological dimensions (L. J. Siever & K. L. Davis, 1991) with participants with the relevant Axis I disorders. The authors assessed participants at baseline and at 6-, 12-, and 24-month follow-up evaluations. BPD showed significant longitudinal associations with major depressive disorder and posttraumatic stress disorder. AVPD was significantly associated with anxiety disorders (specifically social phobia and obsessive-compulsive disorder). Two of the four personality disorders under examination (STPD and OCPD) showed little or no association with Axis I disorders.     

Lateralized impairment of the emotional enhancement of verbal memory in patients with amygdala-hippocampus lesion

This study investigated amygdala-hippocampus's functional asymmetry in the emotional modulation of memory for stories. Thirty-nine, right-handed, drug-resistant epilepsy patients who had been submitted to unilateral temporal lobectomy (19 left and 20 right) watched either an arousing or neutral version of a story presented audio-visually. The slide sequence was the same in the neutral and arousing version, the narratives were matched for structure and comprehensibility. The set and order of the 11 slide sequence were identical in both conditions. Free recall and recognition measures were taken 2h after story presentation. Subjects in the TLE group who watched the arousing version recalled more details than the subjects who watched the neutral version (t(37)=3.4,p<.001). The group who watched the arousing version recalled more details of the phase 2 of the story (t(37)=6.76,p<.001). Scores in both conditions did not differ between control subjects and temporal lobectomy patients. When the right and left lesioned groups' results were analyzed separately, it was observed that the two groups did not differ in their recall of the neutral version. The right lesioned group recalled more items of the arousal than the neutral version (Z=-3.55,p<.001). However the left lesioned group did not show the memory enhancement for the emotional version, in this group it was only found an enhanced recall of the more pictorial emotional segment of the narrative (Z=-3.11,p<.001). This illustrates that the right amygdala can influence retention of complex emotional stimuli with verbal and pictorial arousing properties. We concluded that an intact left amygdala-hippocampus is important for enhancement of memory related to emotionally arousing verbal material.     

Optimism, Pessimism, and Hope in Durkheim

In Book Two, Chapter (1), of The Division of Labor in Society (1984) entitled "The Progress of the Division of Labor and Happiness", Emile Durkheim (1858–1917) stages a provocative encounter between the attitudes of optimism and pessimism, an encounter that reveals certain problematic assumptions regarding the status of hope in relation to the project of binding oneself to life under conditions of anomie. Durkheim's theoretical assault on the utilitarian-based optimism of his day is accomplished against the backdrop of a critical pessimism that is shown to be equally untenable. However, his critique leaves the question of the status of hope in relation to the question of human happiness unclarified and ambiguously framed, even as Durkheim defends hope against the despair of pessimism. The essay concludes with a critical appraisal of Durkheim's partial critique of pessimism and a few observations regarding the links between memory, expectation, pessimism, suicide, hope, and happiness.     

Lesbian, Gay, and Bisexual Identity Scale (LGBIS): construct validation, sensitivity analyses and other psychometric properties

According to Mohr and Fassinger (2006), identity is seen as both self-identification and collective identification with values, beliefs, traits or behaviours and attachments. Their Lesbian, Gay, and Bisexual (LGB) multidimensional identity model accounts for important variables regarding the constitution of identities. This model not only accesses numerous dimensions of the lives of LGB individuals, but is also based on a body of research that recognizes how LGB difficulties are caused by societal intolerance and marginalization (Mohr & Fassinger, 2000). The Lesbian, Gay, and Bisexual Identity Scale (LGBIS; Kendra & Mohr, 2008) constitutes an operationalization of this multidimensional model, and the aim of this article is to present its construct validity by analysing its factor structure using a sample of Portuguese lesbian, gay and bisexual participants. Results from exploratory and confirmatory factor analyses, as well as from factor invariance analysis across sub-samples are presented. In a general way, the factor structure obtained in this study follows the original proposal of Kendra and Mohr's (2008) LGBIS. Moreover, scale sensitivity analyses are presented in order to check for eventual differences in the factor structure and/or factor intercorrelations regarding participant gender and sexual orientation. These results are then discussed in the light of LGB identity models.     

Factor analysis of ipsative data: a simulation study

This paper introduces a summary on how to proceed to conduct a factor analysis when the input data are ipsative. The classical factor analysis procedures cannot be used because the covariance matrix is singular. Additionally, previous research on the optimal conditions to conduct factor analysis for ipsatized data is reviewed, and the results of a simulation study are presented. The study includes conditions of sample size, model complexity, and model specification (correct vs. incorrect). The results suggest that researchers should be careful when factor analyzing ipsatized data, particularly if they suspect that the model is incorrectly specified and includes a smaller number of factors.     

Processing prefixes and suffixes in handwriting production

Previous research showed that handwriting production is mediated by linguistically oriented processing units such as syllables and graphemes. The goal of this study was to investigate whether French adults also activate another kind of unit that is more related to semantics than phonology, namely morphemes. Experiment 1 revealed that letter duration and inter-letter intervals were longer for suffixed words than for pseudo-suffixed words. These results suggest that the handwriting production system chunks the letter components of the root and suffix into morpheme-sized units. Experiment 2 compared the production of prefixed and pseudo-prefixed words. The results did not yield significant differences. This asymmetry between suffix and prefix processing has also been observed in other linguistic tasks. In suffixed words, the suffix would be processed on-line during the production of the root, in an analytic fashion. Prefixed words, in contrast, seem to be processed without decomposition, as pseudo-affixed words.     

Generalization gradients in human predictive learning: Effects of discrimination training and within-subjects testing

Generalization gradients have been investigated widely in animal conditioning experiments, but much less so in human predictive learning tasks. Here, we apply the experimental design of a recent study on conditioned fear generalization in humans (Lissek et al., 2008) to a predictive learning task, and examine the effects of a number of relevant procedural parameters drawn from the generalization literature in animal conditioning. Experiment 1 shows that prior discrimination learning and steady-state testing procedures sharpen the gradient; Experiment 2 shows that within-subjects testing of the range of generalization stimuli also sharpens the gradient. In addition, Experiment 2 shows that, in case of very flat initial generalization, an orderly gradient can reveal itself through differential rates of extinction learning. Finally, Experiment 2 also evidenced an orderly gradient of generalization-of-extinction. These results suggest that discrimination processes have an important effect on the generalization of predictive learning in humans, and highlight behavioral analogies between animal conditioning and human predictive learning.