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.     

Optimizing treatment of schizophrenia. Enhancing affective/cognitive and depressive functioning

Recognition and treatment of schizophrenia has largely focused on positive symptoms of the disorder, such as delusions, hallucinations, and disorganization. However, other important symptoms, such as depression, cognition, and social functioning, have not received comparable attention. Fifty percent of schizophrenic patients suffer from comorbid depression, which is a major risk factor for suicide in this population, while 10% to 25% suffer from comorbid obsessive-compulsive disorder. Cognitive deficits commonly observed in patients with schizophrenia include problems with concentration, attention, and memory, as well as problem-solving and verbal skills. These deficits are observed at early stages of the illness and can predict deficits in functional capabilities, such as occupational and social skills, educational attainment, and the ability to live independently. The severity of such impairments affects all patient in this population, including up to 10% of patients working full time and up to one third of those working part time. In light of the debilitating effects of depression, cognitive impairment, and other aspects of affective functioning on the quality of life of patients with schizophrenia, physicians need to partner with their patients to address these concerns and determine an appropriate treatment regimen. This can be done with simple functional-based cognitive questioning, the use of evidence-based psychosocial practices, and psychoeducation on the many pharmacotherapeutic options. It is recommended that depressive or suicidal symptoms of schizophrenia be treated with an antidepressant or mood stabilizer only if the symptoms have not subsided after treatment of the psychosis with an atypical antipsychotic. Additionally, relative to older medications, atypicals have demonstrated benefit in improving some of the cognitive impairments.     

Abstract analogies and positive transfer in artificial grammar learning.

Following Brooks and Vokey (1991), we show that positive transfer to new items generated from an artificial grammar in which the vocabulary has been changed from training to test can be based on "abstract analogy" to specific training items (specific similarity) rather than abstraction of a grammar and symbol remapping rules, even with remapping unique to each test item. The results confirm that transcendence over symbols provides no support for the implicit learning of abstract structure. Ironically, they also show that the effect of specific similarity does not depend on surface characteristics of the items, but the residual effect of grammaticality does.     

Body-esteem in Swedish 10-year-old children

This study examined body-esteem in 10-yr.-old children. The study group comprised 960 schoolchildren, 515 girls and 445 boys (M age= 10.4, SD=0.5). Analysis showed that girls who were overweight had more negative body-esteem on all dimensions (weight, appearance, and attribution). The overweight boys had more negative perceptions on only two dimensions (weight and appearance). Twice as many girls perceived themselves as too fat (20%) as too skinny (10%). Of the girls who perceived themselves as fat, only 31% were overweight; similarly only 33% of the boys who perceived themselves as fat were overweight. The children's perception of their weight seemed as important as their actual weight and was associated with their body-esteem in the same way. Although few children had dieted (7% of the girls and 5% of the boys), the ones who had dieted had more negative body-esteem than children who had not dieted.     

Greed, death, and values: from terror management to transcendence management theory

Research supporting terror management theory has shown that participants facing their death (via mortality salience) exhibit more greed than do control participants. The present research attempts to distinguish mortality salience from other forms of mortality awareness. Specifically, the authors look to reports of near-death experiences and posttraumatic growth which reveal that many people who nearly die come to view seeking wealth and possession as empty and meaningless. Guided by these reports, a manipulation called death reflection was generated. In Study 1, highly extrinsic participants who experienced death reflection exhibited intrinsic behavior. In Study 2, the manipulation was validated, and in Study 3, death reflection and mortality salience manipulations were compared. Results showed that mortality salience led highly extrinsic participants to manifest greed, whereas death reflection again generated intrinsic, unselfish behavior. The construct of value orientation is discussed along with the contrast between death reflection manipulation and mortality salience.     

A multinomial logit analysis of methods used by persons who completed suicide

This paper presents a multinomial logit analysis of the methods used by Taiwanese individuals who completed suicide between 1991 and 1993. We investigated the influence of age, gender, urban or rural residence, seasons, and occupations on the six "choices" of suicide methods. The findings suggest that a systematic pattern exists between the choice of method and demographic characteristics of persons who have completed suicide. Most of the different patterns of suicide by sex, age, occupation, or residence can be understood by the different availability and accessibility to the means of suicide faced by the individuals. Our findings support Becker's (1962, 1974, 1993) contention that all kinds of human behavior or choices are shaped by the constraints imposed on the individuals. The findings also have important policy implications for suicide prevention in that they support Lester's advocacy to prevent or reduce suicide incidents by limiting availability, blocking accessibility, or "inconveniencing" the suicidal individuals.     

Are there capacity limitations in symmetry perception?

Previous researchers have proposed that there are two types of symmetry detection: one based on crude preattentive symmetry judgments and another based on detailed scrutiny of individual parts (Barlow & Reeves, 1979; S. E. Palmer & Hemenway, 1978; Royer, 1981). Four experiments were conducted to examine capacity limits in different symmetry judgments. Observers were required to discriminate between random patterns and approximate symmetry (Experiments 1 and 3) or between perfect and approximate symmetry (Experiments 2 and 4). The patterns were divided into two sets of dots, presented either simultaneously or successively. A comparison of accuracy under these two presentation conditions suggested that symmetry detection involves an analysis that is spatially parallel but coarse, regardless of either task difficulty or task type (detecting symmetry vs. detecting asymmetry).     

Marital conflict and acculturation among Mexican American husbands and wives

This study examined the relationship between acculturation and multiple dimensions of marital conflict among Mexican American husbands and wives. Participants were 151 husbands and wives who were recruited from a health maintenance organization in northern California and individually interviewed. More acculturated husbands and wives engaged in less avoidance of conflict and were more expressive of their feelings in an argument. Husbands who were more acculturated reported more conflict concerning sex and consideration for the other. Bicultural and more acculturated husbands reported that their wives were more verbally and physically aggressive, compared with mono-Mexican husbands. The findings provide evidence that more acculturated husbands and wives are involved in more direct expressions of conflict in their marriages, compared with less acculturated husbands and wives.     

The language-specific nature of grammatical development: evidence from bilingual language learners

The fact that early lexical and grammatical acquisition are strongly correlated has been cited as evidence against the view that the language faculty is composed of dissociable and autonomous modules (Bates & Goodman, 1997). However, previous studies have not yet eliminated the possibility that lexical-grammar associations may be attributable to language-general individual differences (e.g. children who are good at learning words are good at learning grammar). Parent report assessments of toddlers who are simultaneously learning English and Spanish (n = 113) allow an examination of the specificity of lexical-grammar relationships while holding child factors constant. Within-language vocabulary-grammar associations were stronger than cross-language relationships, even after controlling for age, proportion of language exposure, general language skill and reporter bias. Similar patterns were found based on naturalistic language samples (n = 22), ruling out a methodological artifact. These results are consistent with the view that grammar learning is specifically tied to lexical progress in a given language and provide further support for strong lexical-grammatical continuity early in acquisition.