Extreme Values of Maternal Serum Analytes in Second Trimester Screening: Looking Beyond Trisomy and NTD’s

Second trimester maternal serum screening can identify high risk pregnancies and fetuses at risk for birth defects (in addition to those in the standard interpretation). The purpose of this study was to quantify such risks to improve counseling. We compared outcomes of 692 pregnancies that had abnormal levels of at least one analyte with a cohort of 713 pregnancies with normal analytes. Increased risks include: demise with high AFP and low uE3; intrauterine growth restriction with high AFP, high and low hCG, and low uE3; placental abnormalities with high AFP; fetal stress with high AFP and high hCG. Birth defects are increased with high AFP, high hCG, and low hCG. When two or more analytes are abnormal, 46% have a poor outcome. Abnormal levels of maternal serum analytes provide information in addition to the risks for neural tube defects, Down syndrome, and trisomy 18. This information is important for counseling and pregnancy management.     

Changes in alcohol intake in response to transdiagnostic cognitive behaviour therapy for eating disorders

Objective

The aim of this study was to examine how alcohol intake changes during and after transdiagnostic cognitive behaviour therapy for eating disorders (CBT-E). Additionally, the paper considers the relationship between alcohol consumption, eating disorder diagnosis and current major depressive episode at the time of first assessment.

Method

One hundred and forty nine outpatients with an eating disorder (body mass index over 17.5) were divided into high or low alcohol intake groups (HIG and LIG) according to their intake at pre-treatment assessment. Their alcohol intake and eating disorder psychopathology were examined over the course of treatment and follow-up.

Results

There was no difference between the groups on response of the eating disorder to treatment. The HIG significantly reduced their alcohol intake following treatment whilst the intake of the LIG remained stable over the course of treatment and follow-up. There were no group differences in major depression and overall severity of eating disorder at baseline.

Conclusions

The response to CBT-E was not influenced by baseline level of alcohol use. The mean alcohol intake of the heavy drinking subjects decreased without being specifically addressed by the treatment.     

Gender Differences in the Effects of Acute Stress on Spatial Ability

Although reports that men and women differ in spatial ability are common, recent research examining stress effects on spatial navigation have not included analyses of gender differences. The current study investigated cue perception and mental rotation after an acute cold-water hand immersion stress in 156 undergraduates from the western United States. Gender differences were observed in spatial performance and spatial anxiety. Discriminant analysis revealed that distal gradient cue identification and mental rotation reaction times as well as spatial anxiety differed among men and women exposed to the acute stress and their warm-water hand immersion controls. These results indicate that stress differentially alters spatial performance in men and women, and underscores the importance of assessing gender differences when examining spatial ability.     

The role of atypical antipsychotics in glucose/insulin dysregulation and the evolving role of the psychiatrist in a new era of drug treatment options

This article examines the issue of atypical antipsychotics, glucose/insulin, and other metabolic derangements (ie, metabolic syndrome), including a general introduction to the health concerns of our patients, a review of the literature, possible mechanisms of antipsychotic induced glucose dysregulation, monitoring approaches, and management and prevention of metabolic syndrome. Literature review leads to mechanism hypotheses and risk estimations, leading to guidelines for monitoring and treatment. The patient population suffers from a higher degree of baseline metabolic dysregulation resulting in cardiovascular disease through components of the metabolic syndrome, and this risk increases with administration of atypical antipsychotic medication at different rates, depending on both drug and patient risk factors. The growing knowledge of mechanisms behind drug induced glucose/insulin and other metabolic dysregulation, as well as advances in pharmacogenomics, will help refine drug selection and monitoring for adverse, life-threatening metabolic effects.     

Working memory span: the effect of prior learning

Recent work suggests that working memory span (WMS) tasks are not simple measures of the capacity to simultaneously store and process new information. Instead, these measures may be influenced by numerous factors, including proactive interference (PI). The current study examined whether WMS, like other memory tasks, is also influenced by PI from prior memory experiments. Experimentally experienced and naive participants completed a speaking span task. Span scores were lower for experienced than for naive participants, but other cognitive scores were not. In combination with other work, these results suggest that WMS estimates are not pure measures of capacity and may be partially determined by PI.     

Switching languages, switching palabras (words): an electrophysiological study of code switching

Switching languages has often been associated with a processing cost. In this study, the authors used event-related potentials to compare switches between two languages with within-language lexical switches as bilinguals read for comprehension. Stimuli included English sentences and idioms ending either with the expected English words, their Spanish translations (code switches), or English synonyms (lexical switches). As expected, lexical switches specifically enhanced the N400 response in both context types. Code switches, by contrast, elicited an increased negativity over left fronto-central sites in the regular nonidiomatic sentences (250-450 ms) and a large posterior positivity (450-850 ms) in both context types. In addition, both lexical and code switches elicited a late frontal positivity (650-850 ms) relative to expected completions, especially in idioms. Analysis of the individual response patterns showed correlations with vocabulary skills in English and in Spanish. Overall, the electrophysiological data suggest that for some speakers in some contexts, the processing of a code switch may actually be less costly than the processing of an unexpected within-language item.     

End-of-life decisions: a failure to communicate

Lustig relates the importance of knowledge in bioethics and effective communication between patient and caregivers in dealing with dilemmas involved with therapy and end-of-life choices. He claims that it is necessary that the medical school curricula should incorporate specific strategies for better clinical communication, which may reduce the number of dilemmas encountered by professionals.     

Comparison of naturalistic and arbitrary discriminative stimuli during schedule thinning following functional communication training

We replicated and extended research on incorporating naturalistic discriminative stimuli into schedule thinning following functional communication training with three boys with autism spectrum disorder who engaged in severe behavior. Comparing naturalistic to arbitrary discriminative stimuli, two participants demonstrated differentiated communication in fewer sessions when arbitrary stimuli were used, while the third participant mastered the discriminations in a comparable number of sessions. Although previous research has demonstrated success in rapidly thinning the schedule with arbitrary stimuli, we extended this line of research by evaluating the extent to which differentiated communication would maintain during rapid schedule thinning in both naturalistic and arbitrary conditions. Two participants' communication remained differentiated, and in both conditions, during rapid schedule thinning. However, neither discrimination maintained for the third participant. Results are discussed in terms of the existing literature and directions for future research.     

Enhancing Social Responsibility and Prosocial Leadership to Prevent Aggression,Peer Victimization,and Emotional Problems in Elementary School Children

Testing the theories that form the basis of prevention programs can enhance our understanding of behavioral change and inform the development, coordination, and adaptation of prevention programs. However, theories of change showing the linkages from intervention program components to risk or protective factors to desired outcomes across time are rarely specified or tested. In this 2‐year longitudinal study, we test the theory that increases in two protective factors (i.e., children's prosocial leadership and their teachers’ expectations of social responsibility) targeted by the WITS Programs (Walk Away, Ignore, Talk it Out, and Seek Help) would be associated with declines in peer victimization, aggression, and emotional problems. Participants included Canadian students, in grades 1–4 at baseline (n = 1329) and their parents and teachers. Consistent with our theory of change, variability in program implementation (adherence and integration) and in children's use of program skills (child responsiveness) are related to increases in both protective factors. Increases in these protective factors are associated with subsequent declines in children's aggression, victimization, and emotional problems. We discuss how enhancement of these protective factors may operate to improve child outcomes and the need for theory‐based research to refine and improve the effectiveness of intervention strategies and to improve program scale‐up.