Ayahuasca's Antidepressant Effects Covary with Behavioral Activation as Well as Mindfulness.

Ayahuasca, a plant-based hallucinogen that serves as a spiritual medicine in South America, has improved depression in at least one placebo-controlled clinical trial. Case studies suggest that dramatic behavioral changes often follow the Ayahuasca ceremony, but most explanations of antidepressant effects focus on changes in mindfulness. This study investigated whether both mindfulness and behavioral activation might contribute to these anti-depressant effects. We surveyed individuals (N = 152) about their changes in depressive symptoms, behavioral activation, and mindfulness after an Ayahuasca experience. Mindfulness was strongly associated with reduced depression severity (r = - .670, p < .001), while behavioral activation was moderately linked (r = - .474, p < .001). Changes in depressive symptoms (Center for Epidemiological Sciences Depression Short Form [CES-D-10]) covaried with subscales from the Five Facet Mindfulness Questionnaire [FFMQ] and Experiences Questionnaire [EQ], confirming previous findings (ß = -.57, 95% CI -5.70, -3.25), p < .001). In addition, a modification of the Behavioral Activation for Depression Scale-Short Form [BADS-SF] accounted for significant unique variance in the improvements in depression (ß = - .16, 95% CI -6.32, -0.08), p < .05). Changes in behavioral activation likely serve as a mechanism underlying Ayahuasca's antidepressant effects. Future clinical trials could benefit from tracking behavioral activation.

Autophagy is essential to suppress cell stress and to allow BCR-Abl-mediated leukemogenesis.

Hematopoietic cells normally require cell extrinsic signals to maintain metabolism and survival. In contrast, cancer cells can express constitutively active oncogenic kinases such as BCR-Abl that promote these processes independent of extrinsic growth factors. When cells receive insufficient growth signals or when oncogenic kinases are inhibited, glucose metabolism decreases and the self-digestive process of autophagy is elevated to degrade bulk cytoplasm and organelles. Although autophagy has been proposed to provide a cell-intrinsic nutrient supply for mitochondrial oxidative metabolism and to maintain cellular homeostasis through degradation of damaged organelles or protein aggregates, its acute role in growth factor deprivation or inhibition of oncogenic kinases remains poorly understood. We therefore developed a growth factor-dependent hematopoietic cell culture model in which autophagy can be acutely disrupted through conditional Cre-mediated excision of the autophagy-essential gene Atg3. Treated cells rapidly lost their ability to perform autophagy and underwent cell cycle arrest and apoptosis. Although Atg3 was essential for optimal upregulation of mitochondrial oxidative pathways in growth factor withdrawal, this metabolic contribution of autophagy did not appear critical for cell survival, as provision of exogenous pyruvate or lipids could not completely rescue Atg3 deficiency. Instead, autophagy suppressed a stress response that otherwise led to p53 phosphorylation and upregulation of p21 and the pro-apoptotic Bcl-2 family protein Puma. Importantly, BCR-Abl-expressing cells had low basal levels of autophagy, but were highly dependent on this process, and rapidly underwent apoptosis upon disruption of autophagy through Atg3 deletion or treatment with chemical autophagy inhibitors. This dependence on autophagy extended in vivo, as Atg3 deletion also prevented BCR-Abl-mediated leukemogenesis in a cell transfer model. Together these data demonstrate a critical role for autophagy to mitigate cell stress, and that cells expressing the oncogenic kinase BCR-Abl appear particularly dependent on autophagy for cell survival and leukemogenesis.

Personal characteristics and contextual factors associated with residential expenditures for individuals with mental retardation.

A multivariate analysis was done to determine the relative importance of facility, resident, and community characteristics to expenditures. Facility factors associated with higher expenditures included ownership, facility size, facility services, and location. Individuals with a greater number of activity of daily living limitations, developmental disabilities, and more severe levels of mental retardation had higher expenses. Findings could improve our understanding of the costs of long-term residential care, assisting us to economically and effectively bring this population into the community. Data used are from the 1987 National Medical Expenditure Survey Institutional Population Component.

The case of disability in the family: impact on health care utilization and expenditures for nondisabled members.

Families with a disabled member undergo heightened emotional and financial stress, which can arise from caring for the person with one or more disabilities over the life course or at the end of life. Because health care resources are strained by the needs of the disabled family member, nondisabled members are often limited in health care access and utilization when they are most in need of care. This analysis uses the National Medical Expenditure Survey to describe families with disabled members, based on multiple definitions of disability, and to examine health care utilization and expenditures by nondisabled family members. Indications of higher use of medical care by adult, nondisabled members of such families support the frequent reports in the literature of stress occurring in these situations. The signals of a household rationing effect for families near and at poverty levels should alert policy makers to consider the needs of the whole family when creating or modifying assistance programs.

Emotional processing during eye movement desensitization and reprocessing therapy of Vietnam veterans with chronic posttraumatic stress disorder.

This study examined emotional processing and outcome in 17 Vietnam veterans with chronic posttraumatic stress disorder (PTSD) who underwent eye movement desensitization and reprocessing (EMDR) therapy, with and without the eye movement component, in a crossover design. Results supported the occurrence of partial emotional processing, but there were no differences in its extent in the eye-movement versus eyes-fixed conditions. Therapy produced a modest to moderate overall improvement, mostly on the impact of Event Scale. There was slightly more improvement in the eyes-fixed than eye-movement condition. There was little association between the extent of emotional processing and therapeutic outcome. In our hands, EMDR was at least as efficacious for combat-related PTSD as imaginal flooding proved to be in a previous study, and was better tolerated by subjects. However, results suggest that eye movements do not play a significant role in processing of traumatic information in EMDR and that factors other than eye movements are responsible for EMDR's therapeutic effect.

Emotional processing and outcome of imaginal flooding therapy in Vietnam veterans with chronic posttraumatic stress disorder.

This study examined emotional processing and outcome in 20 Vietnam veterans with chronic posttraumatic stress disorder (PTSD) who underwent imaginal flooding therapy. Results supported the occurrence of emotional processing, as manifest in significant activation, within-session habituation, and partial across-session habituation of physiologic and self-reported process variables. The flooding therapy produced only modest overall improvement, which was statistically significant for avoidance symptomatology measured by the impact of Events Scale (IOES) and number of intrusions per day recorded by the subject in a log. Symptomatic improvement appeared to generalize from a treated to an untreated experience. Heart rate activation during the first flooding session predicted a decrease in daily number of intrusive combat memories across the therapy. Otherwise, there was little association between extent of emotional processing and therapeutic outcome. The results provide limited support for the notion that mobilization of psychophysiologic arousal during exposure therapy predicts improvement.

Surgical removal of choroidal neovascular membranes.

Choroidal neovascularization is an important disease process that can result in severe vision loss in the affected eye. It has been a challenge for ophthalmic physicians to manage this complicated disease, especially when the neovascularization is subfoveal. Our increased understanding of macular disorders has allowed the development of advanced instrumentation and techniques in the treatment and management of choroidal neovascularization. As a treatment alternative to laser therapy, skilled vitreoretinal surgeons today have the technical ability to partially restore and maintain central visual function by surgically removing subfoveal choroidal neovascular membranes. Management of this condition may consist of monitoring the neovascularization, performing laser therapy, or surgically removing the choroidal neovascularization. This paper is limited to the surgical management of this disorder.

Have we succeeded in reducing barriers to medical care for African and Hispanic Americans with disabilities?

There has been considerable progress in reducing barriers to care for African and Hispanics Americans. Yet current research indicates that overall African and Hispanic Americans are disproportionately encountering barriers to care. Unfortunately very little is known regarding the status of African and Hispanic Americans with disabilities. The purpose of this paper is to assess by using data from the 1987 National Medical Expenditure Survey (NMES), the degree of disability for African, Hispanic and Native Americans and the extent to which it is correlated with the use of services. The findings report that as in the case of other African and Hispanic Americans, African and Hispanic Americans with disabilities disproportionately encounter barriers to care. They are more likely than whites to lack insurance, a regular provider and less likely to see a doctor during the year. The implications of these findings for the care of persons with disabilities are discussed.

Dynamic process of movement in residential settings.

Findings from the 1987 National Medical Expenditure Survey show that almost 16% of individuals who spent some time in a residential facility during 1987 moved into other living arrangements during 1987. A smaller number had multiple moves during that period. However, this level of movement did not result in significant changes in the residential population between the beginning and end of 1987. Most movement that occurred was between residential facilities of the same type. For the most part, individuals ended the year in the same type of residential setting where they began the year. These findings suggest that there is considerably more mobility among residential populations than can be observed by examining annual rates of change in residential populations.

The use of ambulatory health care services by American Indians with disabilities.

Although most American Indians and Alaska Natives have access to health care through the Indian Health Service (IHS), it is uncertain whether IHS is able to provide all necessary health services to those with disabilities. Although IHS eligibles can use health services other than those provided or sponsored by IHS, this may be precluded by high rates of poverty, low rates of other health insurance coverage, and the lack of private providers in many areas inhabited by this population. Using data from the 1987 Survey of American Indians and Alaska Natives--the only nationally representative health care survey of persons eligible for IHS--this study examines the use of ambulatory health care for IHS eligibles with disabilities. Comparisons with the total US population showed similar rates of ambulatory care use for most categories of disability, but a higher frequency of use for the total US population. Findings also show that IHS provides most of the health care for its eligible population, although non-IHS care is also used. After controlling for the effects of sociodemographic characteristics and health insurance coverage, variables indicating disabilities due to health problems were found to have statistically significant effects on the likelihood of using non-IHS care. Furthermore, persons with activity limitations had a higher than average likelihood of using most of their health care at non-IHS providers. These findings suggest that for some persons with disabilities, it is necessary to supplement IHS care with services from other providers.

Pre-Vietnam contents of posttraumatic stress disorder veterans' service medical and personnel records.

We reviewed the pre-Vietnam contents of the service medical and personnel records of 250 Vietnam combat veterans, in an attempt to identify factors predisposing to the development of posttraumatic stress disorder (PTSD). PTSD and non-PTSD veterans did not differ significantly on self-reported medical history items, sick call visits, or military efficiency and conduct ratings. There were trends for PTSD veterans to have lower arithmetic aptitude, more self-reported school difficulties, and (paradoxically) lower pulse rate at military induction.

Hospitals hand over gift shop operation.

Many hospitals are re-examining their gift shop operations and concluding that outside experts can do it better. Although only an estimated 30 hospital gift shops are operated by management services companies, interest in outside companies is growing as executives recognize that hospital gift shops can be extremely lucrative, and that hospital gift shop volunteers are an endangered species.

Psychiatric complications during flooding therapy for posttraumatic stress disorder.

The authors use six case vignettes to illustrate underrecognized complications occurring during flooding therapy for posttraumatic stress disorder (PTSD), including exacerbation of depression, relapse of alcoholism, and precipitation of panic disorder. A common denominator to the majority of these cases appears to be the mobilization of negative posttrauma appraisal, accompanied by shame, guilt, and anger. The authors suggest that flooding may not be helpful for these negative emotions in the manner that it is for anxiety. Suggestions for preventing and treating complications of flooding therapy for PTSD include employing more cognitive forms of therapy in cases at risk; supporting abstinence from alcohol and other substances; providing adjunctive pharmacologic treatment as indicated, e.g., tricyclics for depression or panic; and providing long-term follow-up.

Rehabilitation service utilization models: changes in the opportunity structure for disabled women.

The focus of this paper is the opportunity structure for rehabilitation and subsequent outcome for disabled women, in comparison with disabled men. From evidence cited in the literature the differential provision of rehabilitation and other supportive services to disabled women suggests variation in outcome, based on two analytic service utilization models of rehabilitation: medical and psychosocial. Aggregate trend data (1972 and 1978) were used in the analysis of adult disabled groups, by gender and selected disabling conditions. There are two striking results from the analysis of these data sets. One indicates that receipt of rehabilitation is greatly influenced by sociodemographic factors, particularly gender and age. A detailed examination of the combination effects of gender and other sociodemographic variables shows that there are subtleties, such as an interaction between race and gender and education and gender, as well as between age and gender, that put uneducated, younger, white women at a disadvantage in their access to rehabilitation resources. The analysis of these sociodemographic factors over two points in time, however, demonstrates what can be considered a diffusion of the distinctions of social inequality, probably due to changes in rehabilitation legislation that redefined eligibility criteria for rehabilitation services and expanded programme goals. The second result of note is that neither form of rehabilitation is associated with a positive outcome, in this case ability to work. In the earlier data set (1972), indications were that neither the medical model of rehabilitation nor the psychosocial model were effective in returning the individual to the work role. This was true for both men and women.(ABSTRACT TRUNCATED AT 250 WORDS)

Psychometric profile of posttraumatic stress disorder, anxious, and healthy Vietnam veterans: correlations with psychophysiologic responses.

Three groups of Vietnam combat veterans, posttraumatic stress disorder (PTSD, n = 25), anxious (n = 7), and healthy (n = 18), completed a battery of psychometric tests. Measurement of psychophysiologic responses to imagery of individualized combat experiences followed the psychometrics. The PTSD Ss differed significantly from the healthy Ss on almost all measures but showed fewer differences from the anxious Ss. The typical PTSD S was characterized as anxious, depressed, prone to dissociation, and external in locus of control. Correlations with the physiologic responses supported the validity of psychometric scales specifically designed to measure PTSD but cast doubt on the interpretation of traditional measures of overreporting or dissimulation in this disorder.

Psychophysiologic responses to combat imagery of Vietnam veterans with posttraumatic stress disorder versus other anxiety disorders.

We used psychophysiologic techniques to assess responses to imagery of psychologically stressful past experiences in medication-free Vietnam combat veterans classified, on the basis of DSM-III-R criteria into posttraumatic stress disorder (PTSD; n = 7) or non-PTSD anxiety disorder (anxious; n = 7) groups. Scripts describing each individual's combat experiences were recorded and played back in the laboratory. Ss were instructed to imagine the events the scripts portrayed while heart rate, skin conductance, and frontalis electromyogram were recorded. PTSD Ss' physiologic responses were higher than those of anxious Ss. A discriminant function derived from a previous study of PTSD and mentally healthy combat veterans identified 5 of the 7 current PTSD Ss as physiologic responders and all 7 of the anxious Ss as nonresponders. Results of this study replicate and extend results of the previous study and support the validity of PTSD as a separate diagnostic entity.

Prevalence of posttraumatic stress disorder in wounded Vietnam veterans.

Of 156 wounded Vietnam veterans evaluated for posttraumatic stress disorder (PTSD) by a questionnaire and a diagnostic interview in selected cases, 40% had a definite or probable lifetime diagnosis of PTSD. Of the 27 interviewed patients with lifetime PTSD, 81% currently met the PTSD criteria.