Effects of prenatal and postnatal depression, and maternal stroking, at the glucocorticoid receptor gene.

In animal models, prenatal and postnatal stress is associated with elevated hypothalamic-pituitary axis (HPA) reactivity mediated via altered glucocorticoid receptor (GR) gene expression. Postnatal tactile stimulation is associated with reduced HPA reactivity mediated via increased GR gene expression. In this first study in humans to examine the joint effects of prenatal and postnatal environmental exposures, we report that GR gene (NR3C1) 1-F promoter methylation in infants is elevated in the presence of increased maternal postnatal depression following low prenatal depression, and that this effect is reversed by self-reported stroking of the infants by their mothers over the first weeks of life.

Patients' priorities among treatment effects in head and neck cancer: evaluation of a new assessment tool.

BACKGROUND: Patients with head and neck cancer may face decisions between surgery or radiation (with or without chemotherapy) which involve significant trade-offs in functional outcomes. This preliminary investigation is designed to examine patients' priorities among the effects of treatments for head and neck cancer. METHODS: A new instrument designed to allow patients to rank personal priorities among 12 treatment effects was developed and tested. A cross section of patients (19) from pretreatment and posttreatment time periods and 23 controls participated. RESULTS: Preliminary findings indicate high individual variability, with some differences between groups according to treatment time. Differences between patients and controls are evident. We report test-retest reliability and the limitations of this new tool. CONCLUSIONS: The data suggest that measures of health state values should be conducted with patients rather than healthy volunteers. Patients' priorities may be influenced by treatment and some values may be more susceptible to change with experience of treatment effects. This new tool may provide insight into how patients' prioritize the anticipated and experienced effects of treatment for head and neck cancers.

The Leicester 500 Project. Social support and the development of postnatal depressive symptoms, a prospective cohort survey.

BACKGROUND: A prospective epidemiology study evaluated the role of specific social and psychological variables in the prediction of depressive symptomatology and disorders following childbirth in a community sample. Measures of social support used previously in clinically depressed populations facilitated further comparison. METHODS: Nulliparous pregnant women (N = 507) were interviewed during pregnancy with the Interview Measure of Social Relationships (IMSR) and a contextual assessment of pregnancy-related support and adversity and 427 were followed up at 3 months postpartum with the 30-item GHQ, including six depression items. To establish the clinical representativeness of the GHQ, high GHQ scorers and a random subsample of low scorers were interviewed using the SCAN. Regression models were developed using the GHQ Depression scale (GHQ-D), the IMSR and other risk factor data. RESULTS: GHQ-D after childbirth was predicted by lack of perceived support from members of the woman's primary group and lack of support in relation to the event becoming pregnant; this held even after controlling for antenatal depression, neuroticism, family and personal psychiatric history and adversity. Informant-rated deficits in provision of social support also predicted later depression. The size of the primary social network group previously found to be related to depression in women, did not predict depressive symptom development. CONCLUSION: Predictors of depressive symptom development differ from predictors of recovery from clinical depression in women. Interventions should be designed to reduce specific deficits in social support observed in particular study populations.

Delusional phenomenology--dimensions of change.

Although the application of cognitive techniques to both the measurement and modification of delusional beliefs has recently been developed in more theoretical detail (e.g. Chadwick & Lowe, 1994, Behaviour Research and Therapy, 32, 355-367) there has not been an effort to examine the variability of delusional phenomenology across time. In the present study we report on the treatment of 6 individuals who fulfilled DSM-III-R (American Psychiatric Association, 1987) criteria for Delusional Disorder and who received cognitive therapy targeted specifically on the single symptom of their delusional belief(s). Single-case time-series methodology was used to examine the associations between different aspects of delusional phenomenology through baseline and intervention study phases. Belief maintenance factors were found to be significantly associated with conviction in all 3 individuals who responded to the intervention. Negative behaviours, affect associated with the belief, preparedness to talk to others about the belief and insight were associated with conviction in some individuals but not others. Preoccupation and acting on the belief were aspects of delusional phenomenology that were found to systematically vary independent of belief conviction. The results support a multidimensional view of delusional phenomenology and the process of change during cognitive intervention.

Ethical decision-making in interdisciplinary team care.

Most clinical and ethical decisions are made between a patient and his or her physician. However, patients with complex or chronic medical problems are often cared for by a team of professionals from multiple disciplines. Little is known about the process of making ethical decisions between patients and teams of health care providers. The purposes of this article are to examine the process of collective decision-making in interdisciplinary patient care, to present a model for clinical and ethical decision-making, and finally, to discuss ethical decision-making in team care. The benefits and potential risks of interdisciplinary care are discussed and illustrated with case examples. Cleft palate and craniofacial teams are used as a model of interdisciplinary team care.

Alternating fluency in Parkinson's disease. An evaluation of the attentional control theory of cognitive impairment.

One theory for the pattern of cognitive impairment associated with Parkinson's disease is that deficits are apparent only on tasks which rely on the internal control of attention, which in turn is assumed to place heavy demands on limited attentional resources. This theory is evaluated in the present study by examining the performance of Parkinson's disease subjects and matched healthy control subjects on a series of fluency tasks. In one condition, subjects were required to generate exemplars under standard verbal fluency instructions, i.e. either to a single letter or a single semantic category. In a related condition, subjects had to generate exemplars alternately using two fluency probes, which could either be from the same domain, i.e. letter-letter or category-category, or from different domains, i.e. category-letter. The requirement to alternate between fluency probes presumably places greater demands on internal attentional control mechanisms, and in a yoked condition, subjects were given external cue cards to minimize these extra demands. Overall, there was no evidence that Parkinson's disease subjects had a basic fluency deficit, nor were they impaired when required to alternate between probes of the same domain. A specific deficit did emerge, however, for the mixed alternating condition (i.e. category-letter), in which Parkinson's disease subjects produced significantly more perseverative errors and had a significantly lower output. The former of these was reversible by the provision of external cue cards, but the overall output was unchanged. These data do not support the theory of internal attentional control, at least as a general theory of cognitive impairment in Parkinson's disease. To explain the observed pattern, we propose that Parkinson's disease is associated with: (i) a deficit in inhibitory attentional processes, and (ii) an impairment in the maintenance of those internal representations which control action.