Sensitivity and specificity of reliable digit span in malingered pain-related disability

The reliable digit span (RDS) performance of chronic pain patients with unambiguous spinal injuries and no evidence of exaggeration or response bias (n = 53) was compared to that of chronic pain patients meeting criteria for definite malingered neurocognitive dysfunction (n = 35), and a group of nonmalingering moderate-severe traumatic brain injury (TBI) patients (n = 69). The results demonstrated that scores of 7 or lower were associated with high specificity (> .90) and sensitivity (up to .60) even when moderate to severe TBI are included. Multiple studies have demonstrated that RDS scores of 7 or lower rarely occur in TBI and pain patients who are not intentionally performing poorly on cognitive testing. This study supports the use of the RDS in detecting response bias in neuropsychological patients complaining of pain as well as in the assessment of pain-related cognitive impairment in patients whose primary complaint is pain.     

Reliable digit span is unaffected by laboratory-induced pain: implications for clinical use

Reliable Digit Span (RDS) is an indicator used to assess the validity of cognitive test performance. Scores of 7 or lower suggest poor effort or negative response bias. The possibility that RDS scores are also affected by pain has not been addressed thus potentially threatening RDS specificity. The current study used cold pressor-induced pain to investigate the effect of pain on RDS scores. Sixty undergraduate volunteers randomly assigned to one of three conditions (control, simulator, pain) completed the Digit Span subtest from the Wechsler Adult Intelligence Scale-III from which the RDS is derived. No differences in RDS scores were found between the control and pain groups, and neither group scored below 8. Sixty-five percent of the simulator group scored 7 or below. These results suggest that RDS is not affected by pain, and scores of 7 or less in persons with pain can be more confidently attributed to negative response bias.     

Enhancement of auditory fear conditioning after housing in a complex environment is attenuated by prior treatment with amphetamine

Prior exposure to drugs of abuse has been shown to occlude the structural plasticity associated with living in a complex environment. Amphetamine treatment may also occlude some cognitive advantages normally associated with living in a complex environment. To test this hypothesis we examined the influence of prior exposure to amphetamine on fear conditioning in rats housed in either a standard or complex environment. Housing in a complex environment facilitated fear learning to an auditory conditioned stimulus (CS), but not to the training context, relative to animals housed singly or in a social group. Prior treatment with amphetamine eliminated this effect. These results indicate that living in a complex environment facilitates conditional freezing to an auditory CS, and that this effect is abolished by pretreatment with amphetamine.     

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.     

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).     

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.