Chest pain without coronary artery disease: An exploratory comparison with panic disorder

Recent reports have indicated similarities between patients with persistent chest pain of nonorganic origin and patients with panic disorder. In order to explore this association further, we administered a structured interview and three self-report measures (State-Trait Inventory, Beck Depression Inventory, and SCL90-R) to three subject groups: (1) a sample with persistent chest pain (CP; n=14) who had been screened and found to have normal coronary arteries, (2) a sample of patients with panic disorder (PD; n=14), and (3) a sample of matched normals (n=14). CP patients were considered to be free of coronary artery disease (CAD) following normal cardiac catheterization and/or normal thallium stress tests and were not diagnosed initially with panic disorder. PD patients were diagnosed with a standardized psychiatric interview and were free of organic causes of panic. Using an exploratory data analytic approach, the results indicated that both CP and PD samples reported increased levels of state and trait anxiety (p <.0001), depression (p <.01), and somatization (p <.0001) compared with normals. CP patients differed from PD patients in their less frequent use of anxiolytic medication (p <.01) and lower levels of reported panic anxiety and phobic avoidance (p <.0001). These data suggest that persistent chest pain in the absence of CAD shares some features with panic disorder, yet differs from panic in key ways as well. The results are discussed in light of the role of anxiety in contributing to symptom labeling.This research was supported by Grant 86G-491 from the American Heart Association, Texas Affiliate, to J.G.B. H.T. is the recipient of USPHS Research Career Development Award K04-HL-0122246.     

The social phobia and anxiety inventory: Construct validity

The Social Phobia and Anxiety Inventory (SPAI) is a new instrument composed of social phobia and agoraphobia subscales. The latter scale is used to detect social anxiety that may result from agoraphobia. The SPAI's construct validity was assessed through several procedures. First, confirmatory factor analyses were conducted to validate the existence of the two subscales. Second, exploratory factor analyses examined the underlying structure of the social phobia subscale. Third, a Q factor procedure determined if different anxiety diagnostic groups could be differentiated by their SPAI response pattern. The results confirmed the utility of the two SPAI subscales and identified a number of dimensions contained within the social phobia subscale which differed depending upon the specific subject sample. In addition, the complaints of social phobies appeared more homogeneous than those of an agoraphobic comparison group. The results are discussed in terms of construct validity and the sensitivity of the SPAI to various dimensions of social phobia fears.This study was supported in part by NIMH Grants 41852, 30915, 18269, and 16884.     

Lesbian Partner Abuse: Implications for Therapists

Silence surrounds the issue of lesbian battering. Lesbian victims of partner abuse are even less likely than are their heterosexual counterparts to seek help in shelters or from counselors because of the overlay of homophobia that exists both in the battered women's movement and among mental health professionals. In addition, many lesbian and many lesbian-supportive therapists hold an idealized and unrealistic picture of the nature of lesbian relationships, leading them to deny the existence of buttering among lesbian couples. The nature, severity, and prevalence of abuse in lesbian relationships is addressed; current counseling and treatment models dealing with battering relationships are analyzed; and a counselor advocacy model for working with lesbian partner abuse, drawing from the experience of activists in the battered women's movement and our clinical experience, is suggested.     

Combating Homophobia in AIDS Education

Homophobia is a central theme in response to the AIDS epidemic. In this article we review literature explicating the connection between homophobia and AIDS and then call for the integration of antihomophobia elements into AIDS education. We discuss negative messages in portrayals of gay and bisexual men and in discussions of safer sexual practices, as well as materials and educational strategies that explicitly contradict such homophobic messages. We then discuss the emerging trend to exclude lesbian women and gay men in education and programs, suggest guidelines for countering such exclusion, and give examples of creative approaches to inclusion.     

Twenty-four-hour sleep-wake patterns in a nursing home population

Sleep-activity patterns were objectively recorded over a 24-hr period in 19 elderly nursing home residents. On average, both sleep and wake times were observed during every hour of the 24 recorded hours; however, the sleep pattern of the residents was fragmented so that they rarely experienced even a single hour of consolidated time spent sleeping. It is hypothesized that several independent factors, including compensation for lost sleep, increased total time in bed, weakening of social constraints, and deterioration of the circadian sleep-wake rhythm, are interacting to produce this increase in sleep fragmentation.     

Relationship of severity of dementia to caregiving stressors

In studies of individual differences and longitudinal changes in stress and coping among dementia caregivers, assessing severity of patient impairment is critically important. It is proposed that with the progression of dementia, cognitive impairment may steadily increase, but other stressful behavioral symptoms peak at various stages of dementia. Cross-sectional data from 49 caregiving families and longitudinal follow-up data from 48 families suggest that instrumental self-care deficits begin early in dementia, and basic self-care deficits increase with dementia severity, but that many distressing behavioral symptoms decrease in late dementia. Assessments of dementia patient severity should be multidimensional, and increases and decreases in various dementia patient stressors over time should be considered as factors influencing caregiver coping.     

Assessing White Racial Consciousness and Perceived Comfort with Black Individuals: A Preliminary Study

This research examined the relationship between White racial consciousness development and perceived comfort with Black individuals. Participants were 339 White undergraduate students from a large southeastern state university who were asked to complete a two-part inventory: part one measuring White racial consciousness development (a five-stage scale) and part two measuring perceived comfort in situations involving Black individuals. An eta coefficient was calculated, providing evidence for the existence of a strong curvilinear relationship between White racial consciousness and perceived comfort with Black individuals η =.23 at p<.0001. These findings suggest that Whites who are completely foreclosed (stage one) or who are well acquainted with Blacks (stage five) are more comfortable in situations with Blacks than Whites who had a moderate amount of contact with them (stages two, three, and four).     

Task-unrelated-thought frequency as a function of age: a laboratory study

Using retrospective reports, Giambra (1977-1978, 1979-1980) found an inverse relation between age and daydreaming/mind wandering. To deal with an alternate explanation of these results based on age-dependent memorial deficiencies and attitudes toward daydreaming/mind wandering and to provide independent convergent validity, five experiments were carried out. Task-unrelated thoughts (TUTs) were taken as the operational definition of daydreams/mind wanderings and their frequency recorded in vigilance tasks. All five experiments found an inverse relation between age (17-92 years, N = 471) and TUTs, confirming the reliability and validity of the earlier studies. The age-dependent reduction in TUTs was considered as evidence of reduced nonconscious information processing with increased age. The results of this study were incompatible with a recent theory that predicts for older individuals an increased input of irrelevant thoughts into working memory due to the older individual's reduced inhibitory control.     

Age, exercise, and coding performance

We investigated the effects of exercise on the coding performance of young and older subjects. Hypotheses were tested that exercise either facilitates spatial localization or reduces susceptibility to distraction in older subjects. In a balanced design, we administered Digit Symbol and Symbol Digit coding tasks to exercisers and nonexercisers at two age levels under conditions of low or high within-task interference. The findings showed higher performance by the exercisers than by the nonexercisers only at the older age level and only with the Symbol Digit task. These findings support the hypothesis that exercise compensates for a loss of spatial localization skills with age. We found no evidence that susceptibility to distraction either increased with age or was affected by chronic exercise.