The use of antidepressants in functional gastrointestinal disorders: new uses for old drugs

Since their introduction 50 years ago, antidepressants have been used in a wide variety of settings involving gastrointestinal (GI) disease. In the 1950s, antidepressants were shown to have some efficacy for the treatment of peptic ulcer disease. This is most likely due to their antihistaminic and anticholinergic effects. Since then, more efficacious and more disease-specific treatments have become available. In the last 20 years, antidepressants have been increasingly used for the treatment of functional gastrointestinal disorders such as irritable bowel syndrome, noncardiac chest pain, and other functional GI disorders. This article will review the rationale for the use of antidepressant drugs for the treatment of functional GI disorders. The role of psychiatric comorbidity in functional GI disorders, the impact of antidepressants on GI motility and visceral sensation, and the ability of these agents to produce improvements in the global well-being and overall quality of life will be reviewed. Finally, guidelines for prescribing and barriers to a patient's acceptance of these agents will be discussed.     

Internet accessibility and usage among urban adolescents in Southern California: implications for web-based health research.

The World Wide Web (WWW) poses a distinct capability to offer interventions tailored to the individual's characteristics. To fine tune the tailoring process, studies are needed to explore how Internet accessibility and usage are related to demographic, psychosocial, behavioral, and other health related characteristics. This study was based on a cross-sectional survey conducted on 2373 7th grade students of various ethnic groups in Southern California. Measures of Internet use included Internet use at school or at home, Email use, chat-room use, and Internet favoring. Logistic regressions were conducted to assess the associations between Internet uses with selected demographic, psychosocial, behavioral variables and self-reported health statuses. The proportion of students who could access the Internet at school or home was 90% and 40%, separately. Nearly all (99%) of the respondents could access the Internet either at school or at home. Higher SES and Asian ethnicity were associated with higher internet use. Among those who could access the Internet and after adjusting for the selected demographic and psychosocial variables, depression was positively related with chat-room use and using the Internet longer than 1 hour per day at home, and hostility was positively related with Internet favoring (All ORs = 1.2 for +1 STD, p < 0.05). Less parental monitoring and more unsupervised time were positively related to email use, chat-room use, and at home Internet use (ORs for +1 STD ranged from 1.2 to 2.0, all p < 0.05), but not related to at school Internet use. Substance use was positively related to email use, chat-room use, and at home Internet use (OR for "used" vs. "not used" ranged from 1.2 to 4.0, p < 0.05). Self-reported health problems were associated with higher levels of Internet use at home but lower levels of Internet use at school. More physical activity was related to more email use (OR = 1.3 for +1 STD), chat room use (OR = 1.2 for +1 STD), and at school ever Internet use (OR = 1.2 for +1 STD, all p < 0.05). Body mass index was not related to any of the Internet use-related measures. In this ethnically diverse sample of Southern California 7(th) grade students, 99% could access the Internet at school and/or at home. This suggests that the Internet is already a potential venue for large scale health communication studies. Adolescents with more psychosocial risk factors or detrimental health behaviors were more likely to use the Internet. Therefore, if used properly, Internet interventions could effectively address the high risk populations. Additional research is needed to gain a more complete understanding of the positive and negative consequences of Internet use among adolescents.     

Amygdala activation to sad pictures during high-field (4 tesla) functional magnetic resonance imaging

Fear-related processing in the amygdala has been well documented, but its role in signaling other emotions remains controversial. The authors recovered signal loss in the amygdala at high-field strength using an inward spiral pulse sequence and probed its response to pictures varying in their degree of portrayed sadness. These pictures were presented as intermittent task-irrelevant distractors during a concurrent visual oddball task. Relative to neutral distractors, sad distractors elicited greater activation along ventral brain regions, including the amygdala, fusiform gyrus, and inferior frontal gyrus. In contrast, oddball targets engaged dorsal sectors of frontal, parietal, and cingulate cortices. The amygdala's role in emotional evaluation thus extends to images of grief and despair as well as to those depicting violence and threat.     

Use of interactive voice response (IVR) technology in health research with children

This article reports on the feasibility of using interactive voice response (IVR) technology to obtain daily reports of attitudes toward alcohol and tobacco use among children 9–13 years of age. Two studies were conducted. The first was an investigation of the use of IVR technology to obtain daily data from a sample of primary school children over a period of 8 weeks. The second was an extension of the research to a large sample of primary and secondary school children in urban and rural areas who provided daily data over a 4-week period. Retention and compliance rates comparable to those obtained with adults were evident in both studies, supporting the feasibility of this technology with children. The results are discussed in relation to the benefits of this methodology for health research, particularly for studies of sensitive topics conducted with children and adolescents.     

Structural brain variation,age, and response time

Response time (RT) generally slows with aging, but the contribution of structural brain changes to this slowing is unknown. We used voxel-based morphometry (VBM) to determine gray matter (GM) and white matter (WM) brain volumes in 9 middle-aged adults (38–58 years old) and 9 seniors (66–82 years old). We correlated brain volumes with RT assessed in both a simple visual stimulus-response task and a visual continuous recognition memory task. No GM correlations with simple RT were significant; there was one WM correlation in the right fusiform gyrus. In the memory task, faster RT was correlated (p<.05, corrected) with less GM in the globus pallidus, the parahippocampus, and the thalamus for both groups. Several Brodmann areas (BA) differed between the groups such that in each area, less GM was correlated with slower RTs in the middle-aged group but with faster RTs in the senior group (BAs 19, 37, 46, 9, 8, 6, 13, 10, 41, and 7). The results suggest that individual differences in specific brain structure volumes should be considered as potential moderating factors in cognitive brain imaging studies.     

A national survey of health care administrators' views on the importance of various chaplain roles

A random sample of hospital administrators throughout the United States was surveyed about their views on the importance of eleven chaplain roles and functions. The 494 respondents fell into three categories: (1) directors of pastoral care departments (N = 132); (2) administrators of hospitals that have a pastoral care department (N = 180); and (3) administrators of hospitals that do not have a pastoral care department (N = 182). All three groups considered all eleven roles to be relatively important, although administrators of hospitals that do not have a pastoral care department gave lower ratings, overall. Meeting the emotional needs of patients and relatives were seen as chaplains most important roles, whereas performing religious rituals and conducting religious services were seen as least important by all three groups. In all but a few instances, the level of importance that administrators assigned to the various roles were positively related to their ratings of their own religiousness and spirituality (r's = .11 to .26, p < .05).     

Differential fan effect and attentional focus

As people study more facts about a concept, it takes longer to retrieve a particular fact about that concept. This fan effect (Anderson, 1974) has been attributed to competition among associations to a concept. Alternatively, the mental-model theory (Radvansky & Zacks, 1991) suggests that the fan effect disappears when the related concepts are organized into a single mental model. In the present study, attentional focus was manipulated to affect the mental model to be constructed. One group of participants focused on the person dimension of personlocation pairs, whereas the other group focused on the location dimension. The result showed that the fan effect with the focused dimension was greater than the fan effect with the nonfocused dimension, which is contrary to the mental-model theory. The number of associations with a concept is indeed crucial during retrieval, and the importance of the information seems to be accentuated with attentional focus.     

A replication of the MMPI-A PSY-5 scales and development of facet subscales

McNulty, Harkness, Ben-Porath and Williams recently developed Personality Psychopathology Five (PSY-5) scales for the Minnesota Multiphasic Personality Inventory-A (MMPI-A). This study examined these new scales in a sample of 545 adolescents receiving inpatient psychiatric treatment. Item-level principal components analyses were employed to determine the internal structure of each PSY-5 scale and to aid in the creation of facet subscales for each PSY-5 scale. Results suggest that the MMPI-A PSY-5 scales display adequate internal consistency and our findings generally replicate the original work of McNulty et al. but also extend this work by showing that several of the PSY-5 scales may also be subdivided into meaningful lower level dimensions. These facet subscales for each of the MMPI-A PSY-5 scales are offered for further study.     

A review of research on chaplains and community-based clergy in the Journal of the American Medical Association, Lancet, and the New England Journal of Medicine: 1998-2000

Based on the content analysis of quantitative research appearing in three medical journals, the authors conclude that, despite the shared ideal of providing spiritual care to patients on the part of physicians and chaplains, there is little attention given in these journals demonstrating and promoting this shared perspective. Suggestions for future research that would focus on this common medicine/religion interface and concern are noted.