Paradoxical breathlessness in asthma

This study tested the hypothesis that breathlessness in asthma relates linearly to airway obstruction when situational, attentional and emotional influences are held constant via random presentation of different intensities of externally applied airflow obstruction. Adolescents with stable asthma and normal controls (n=25+25) with lung functions of approximately 3.5 l forced expiratory volume in 1 s (FEV₁) breathed through a device which obstructed airflow with five stimulus intensities, analogous to a mean reduction in FEV₁ of 8–66%. A session consisted of 10 blocks, each with presentation of five stimulus intensities plus the baseline resistance of the apparatus. Breathlessness was continuously reported by moving a lever along a 10-point scale. The mean breathlessness was computed per stimulus intensity. Lung function and anxiety were measured before and after the test.

Participants with asthma, not controls, manifested a paradoxical response: they reported significantly more breathlessness, but undifferentially. One patient against 12 controls reported consistently more breathlessness from baseline to severe obstruction. The hypothesis was only supported for controls. Breathlessness did not correlate with severity of asthma, lung function, duration of asthma, number of exacerbations over the last six months, age, sex or anxiety.

It was concluded that the meaning of airflow obstruction in patients with asthma has changed and underlies their paradoxical responses, even when situational, attentional and emotional factors are controlled.     

Magnitude,timing and duration of mood state and cognitive effects of acute moderate exercise in major depressive disorder

BackgroundAcute exercise generally improves mood state and cognitive functioning in healthy adults. However, the impact of acute exercise on primary symptoms in adults with major depressive disorder (MDD) is poorly understood. The present randomized cross-over study evaluated the magnitude, timing, and duration of the psychological effects of 30 min of moderate-intensity cycling exercise compared to quiet rest in 30 adults (21 female) with MDD.MethodsDepressed mood state (Profile of Mood States Short Form-Depression; POMS-D), state anhedonia (anhedonia Visual Analog Scale [VAS], and Dimensional Anhedonia Rating Scale [DARS]), and cognition (inhibition via Stroop and working memory via the 2-back task) were assessed pre, mid, post, 25-, 50- and 75-min after each session.ResultsGeneralized estimating equations demonstrated significant session by time interactions for POMS-D and VAS indicating small-to-large improvements in mood state and anhedonia up to 75 min post-exercise (p < 0.05; Cohen’s d ranges: POMS [-0.69, -0.95]; DARS, [-0.02, 0.16]; VAS [0.33, 0.83]) with greater immediate effects that lessened somewhat across time. For cognition, Stroop reaction time improved during exercise, but was worse at 25- and 50-min post-exercise compared to quiet rest (p < 0.05); no differences were found for 2-back reaction time.LimitationsThe small sample and continued psychological effects at 75 min indicate a potentially longer-lasting response than was measured herein.ConclusionPerforming short bouts of moderate intensity exercise appears to be effective for management of key symptoms (anhedonia, depressed mood state) in adults with MDD. The time immediately post-exercise may be ideal for performing emotionally challenging tasks and/or tasks where a low symptom severity would be helpful (e.g., psychotherapy).     

Responses to symptom induction exercises in panic disorder

Exposure to panic symptoms (interoceptive exposure) is often included as part of treatment for panic disorder (PD), although little is known about the relative effects of particular symptom induction exercises. This study describes responses of individuals with PD and nonclinical controls to 13 standard symptom induction exercises and 3 control exercises. Generally, individuals with PD responded more strongly to symptom induction exercises than did controls. The exercises producing the most fear included spinning, hyperventilation, breathing through a straw, and using a tongue depressor. This study also reports findings regarding specific symptoms triggered by each exercise, the percentage of participants reporting fear during each exercise, and predictors of fear.     

Use of verbal pain measurement in the detection of hidden psychological morbidity among low back pain patients with objective organic findings

Abstract

Patients with positive physical findings to explain low back pain arc believed lo belong to two organic subgroups. One group has organic disease alone: in the other, organic disease is accompanied by psychological disturbance. Separation of patients with medical findings into groups with varying levels of psychological disturbance is difficult, because emotional disturbance is often hidden. In this study, the pain report of 124 patients with organic findings alone, and 50 patients with organic and psychological findings was examined to determine whether pain measurement could he used to identify accurately patients belonging 10 the two groups. the pain groups differed in the use of 43 pain words from the Low Back Pain Symptom Check List. Using a set of weights derived From discriminant analysis. the 33 pain words predicted 99.2% of the patients with organic disease alone and 86.0% of the patients with organic disease and psychological disturbance. The results were replicated in a new sample of 140 patients. Cross-validation shrinkage in accuracy was 8.3%. The results of the two studies suggest that pain measurement may he a useful clinical indicator of psychological disturbance in patients with organic findings.     

Measuring Abuse Sequelae: Validating and Extending the Trauma Symptom Checklist–40

This study used the Trauma Symptom Checklist–40 (TSC–40) to index both childhood sexual abuse (CSA) and childhood physical abuse (CPA) in a college student sample of both men and women (N = 441). Although the TSC–40 was designed as a measure of CSA trauma, this study concludes the measure is appropriately reliable for indexing the traumatic sequelae of CPA as well as CSA in nonclinical samples. This study also explored the effects of gender and abuse severity on resulting symptomatology, finding that women and severely abused individuals report the most negative sequelae. Both CSA and CPA emerged as significant explanatory variables in TSC–40 scale scores beyond gender, supporting its validity for indexing traumatic sequelae in nonclinical samples.     

PTSD Symptoms in College Students Exposed to Interparental Violence: Are they Comparable to those that Result from Child Physical and Sexual Abuse?

Undergraduate students completed the Trauma Symptom Inventory and a childhood history questionnaire that assessed their experience of three types of childhood traumatic events: physical abuse (CPA), sexual abuse (CSA), and interparental violence (CPV). Six posttraumatic stress disorder (PTSD) subscales previously found to be associated with these types of abuse (anxious arousal, anger/irritability, intrusive experiences, depression, tension reduction behaviors, and defensive avoidance) were examined through multiple regression analyses to determine the extent to which each type of trauma history was most predictive of elevated symptomatology. For several subscales, having exposure to interparental violence was the strongest predictor of elevated symptomatology, suggesting that CPV is at least as powerful as CPA or CSA in producing symptoms of PTSD in adulthood.     

Adult Israeli Community Norms for the Brief Symptom Inventory (BSI)

The study aim is to establish Israeli norms for the Brief Symptom Inventory (BSI). A nationwide representative sample of 510 community respondents (age range 35–65, 51.4% women) completed the Hebrew version of the BSI. The data showed high internal reliabilities for the 9 BSI scales, as well as for their total score, indicated by the General Severity Index (GSI). Higher levels of GSI were found for widowed, divorced, and single respondents than for married respondents. Higher GSI was also found for unemployed and retired men than the self-employed and employees, validating the GSI as a measure of distress. Most importantly, the scores of the Israeli GSI, as well as each of the 9 scales, were higher than those reported in either the U.S. or the British norms. These findings may indicate that Israeli society is experiencing relatively high distress, highlighting the need for establishing BSI norms for each culture.     

Test of memory malingering with children: The utility of Trial 1 and TOMMe10 as screeners of test validity

There is a growing body of research suggesting that the shorter versions of the Test of Memory Malingering (TOMM) may provide an accurate assessment of effort in children. During neuropsychological evaluations, some circumstances result in only one completed trial of the TOMM or partial completion of a trial. Research suggests that a cut-score of 40 or 41 on Trial1 is highly predictive of passing the TOMM overall. In the current study, 194 school-age children with academic and/or behavioral problems were used to compare the accuracy of TOMM1 and TOMMe10 (errors on the first 10 items of TOMM1) in predicting passing/failing of TOMM2. For the children in this sample, a score of < 40 items correct (≥ 10 errors) on TOMM1 was highly accurate in predicting a passing performance on the TOMM2 (sensitivity = .80, specificity = .91) with a Negative Predictive Value = .98 at the malingering base rate of 7% (TOMM2 failure in our sample). A score of 2 errors (8 items correct) on the TOMMe10 was slightly less sensitive than that of the TOMM1 (specificity = .96, sensitivity = .53) but with a similar Negative Predictive Value (.96). Consistent with the research from adult populations, TOMM1 and TOMMe10 appear to be quite accurate in predicting performance on the standard administration of the TOMM and may be useful screeners. However, compared to that found in adult samples, slight differences in suggested cutoffs for TOMM1 and TOMMe10 may be warranted for children.     

Symptom Expression and Somatization Among Elderly Korean Immigrants

In a study of expression of symptoms of somatization, depression, and other biopsychological conditions, 70 elderly Korean immigrants in the greater Washington, D.C., metropolitan area (35 who met the criteria for major depression and 35 who did not meet those criteria) were administered a Korean version of the Brief Symptom Inventory (BSI). Subjects who met the criteria for depression had the highest mean score on the BSI somatization dimension compared with other normative samples including a sample of psychiatric inpatients. A factor analysis of data from the BSI showed that for elderly Korean immigrants, a factor of somatization was identified that included the items from the original BSI obsessive-compulsive, somatization, and anxiety dimensions. Items loading on the somatization factor suggest that elderly Korean subjects experience body and mind as a unitary system and tend to communicate the distress associated with old age, cultural adjustment, and family and social changes through somatic symptoms.