Social anxiety and negative interpretations of positive social events: What role does intolerance of uncertainty play?

OBJECTIVE: Although previous studies have demonstrated the association between social anxiety symptom severity and the tendency to appraise positive social events negatively among individuals with social anxiety disorder, no study has examined mediators of this relationship. The current study sought to examine whether intolerance of uncertainty and its subfactors mediate the relationship between social interaction anxiety and the tendency to interpret positive social events negatively. METHOD: One hundred and sixty-five individuals with social anxiety disorder completed measures of social interaction anxiety symptom severity, intolerance of uncertainty, and negative interpretations of positive social events. RESULTS: Total intolerance of uncertainty and the inhibitory-intolerance of uncertainty subscale scores significantly mediated the relationship between social interaction anxiety and negative interpretations of positive events. Exploratory post-hoc analyses regarding the possible contributing role of depression demonstrated mixed results. The same mediation pattern was found in the full sample as well as those without a secondary comorbid mood disorder diagnosis. In contrast, serial mediation showed a mediating role of depressive symptom severity. CONCLUSION: Inhibitory-intolerance of uncertainty plays a role in the relationship between social interaction anxiety and negative interpretations of positive social events.

The association between suicide deaths and putatively harmful and protective factors in media reports.

BACKGROUND: Exposure to media reporting on suicide can lead to suicide contagion and, in some circumstances, may also lead to help-seeking behaviour. There is limited evidence for which specific characteristics of media reports mediate these phenomena. METHODS: This observational study examined associations between putatively harmful and protective elements of media reports about suicide in 13 major publications in the Toronto media market and subsequent suicide deaths in Toronto (2011-2014). We used multivariable logistic regression to determine whether specific article characteristics were associated with increases or decreases in suicide deaths in the 7 days after publication, compared with a control window. RESULTS: From 2011 to 2014, there were 6367 articles with suicide as the major focus and 947 suicide deaths. Elements most strongly and independently associated with increased suicides were a statement about the inevitability of suicide (odds ratio [OR] 1.97, confidence interval [CI] 1.07-3.62), about asphyxia by a method other than car exhaust (OR 1.72, CI 1.36-2.18), about suicide by jumping from a building (OR 1.70, CI 1.28-2.26) or about suicide pacts (OR 1.63, CI 1.14-2.35), or a headline that included the suicide method (OR 1.41, CI 1.07-1.86). Elements most strongly and independently associated with decreased suicides were unfavourable characteristics (negative judgments about the deceased; OR 1.85, CI 1.20-2.84), or mentions of railway (OR 1.61, CI 1.10-2.36) and cutting or stabbing (OR 1.59, CI 1.19-2.13) deaths, and individual murder-suicide (OR 1.50, CI 1.23-1.84). INTERPRETATION: This large study identified significant associations between several specific elements of media reports and suicide deaths. It suggests that reporting on suicide can have a meaningful impact on suicide deaths and that journalists and media outlets and organizations should carefully consider the specific content of reports before publication.

Social Anxiety and Fear of Causing Discomfort to Others: Diagnostic Specificity, Symptom Correlates and CBT Treatment Outcome.

BACKGROUND: Patients with social anxiety disorder (SAD) report fear content relating to the perceived aversive consequences of their anxiety for others in their social environment. However, no studies to date have examined the diagnostic specificity of these fears to SAD as well as predictors to treatment response of these fears. AIMS: To examine relative specificity of fears related to causing discomfort to others, as measured by Social Anxiety-Fear of Causing Discomfort to Others (SA-DOS), among patients with anxiety disorders, obsessive compulsive disorder (OCD) and major depressive disorder (MDD), in addition to relation between dysfunctional attitudes and treatment response among patients with SAD. METHOD: In study 1, a large (n=745) sample of DSM diagnosed OCD, MDD and anxiety disorder participants completed the SA-DOS. In study 2, patient participants with SAD (n=186) participated in cognitive behavioural group therapy (CBGT) and completed measures of social anxiety symptoms and dysfunctional attitudes. RESULTS: In study 1, the SAD group demonstrated significantly elevated SA-DOS scores compared with participants with generalized anxiety disorder (GAD), OCD and panic disorder with or without agoraphobia (PD/A), but not the MDD group. In study 2, CBGT treatment was found to lead to significant reductions in SA-DOS scores. Need for approval (NFA) but not perfectionism, predicted treatment response to fears related to causing discomfort to others, with greater change in NFA relating to greater change in SA-DOS scores. CONCLUSIONS: These findings extend previous research linking allocentric fears to the phenomenology and treatment of SAD.

Beyond Hispanics: sub-ethnic differences in depression, post-traumatic distress, and suicidal ideation among patients with coronary heart disease.

OBJECTIVES: Our study of cardiac outpatients participating in a mental health screening program aimed to explore: a) sub-ethnic differences in the severity and/or prevalence of depression, post-traumatic stress disorder, and suicidal ideation, and b) whether intrusion and avoidance symptoms of distress equally or differentially predict severity of depression among sub-ethnic groups. DESIGN: Five hundred ninety Caucasian (n = 103) and immigrant Hispanic (n = 487) cardiac outpatients were recruited. Participants completed measures of depression and post-traumatic stress symptoms and were categorized into sub-ethnic groups according to regional and national origins. RESULTS: For regional comparisons, South American and Caribbean Hispanic patients exhibited greater symptoms of depression than US born Caucasians (UBC). Significant differences in the proportion of patients screening positive for depression were found among regional subethnic groups. When these groups were further stratified by national origin, Colombian and Dominican patients demonstrated higher levels of depression than UBC patients. Dominican patients reported greater levels of distress than UBC patients. Significant differences in rates of positive depression screens were found among comparisons between UBC and Hispanic national sub-ethnic groups. Finally, stepwise regression analyses revealed that intrusion symptoms predicted depression severity better than avoidance symptoms among all of sub-ethnic groups tested. CONCLUSION: The findings suggest that collapsing ethnic sub-groups into catchall ethnic labels may undermine high resolution screening strategies for concurrent medical and psychiatric conditions.

Outcome of dialectical behaviour therapy for concurrent eating and substance use disorders.

AIM: The current study examined the preliminary efficacy of dialectical behaviour therapy (DBT) adapted for concurrent eating disorders (EDs) and substance use disorders (SUDs). METHOD: A matched randomized controlled trial was carried out with 25 female outpatients diagnosed with concurrent ED and SUD. Participants randomized to the intervention condition received DBT, whereas those randomized to the control condition received treatment as usual (TAU), both for a period of 1 year. A series of measures related to disordered eating, substance use and depression were administered to the participants at the beginning of treatment and at 3, 6, 9 and 12 months into treatment, followed by 3-month and 6-month follow-up assessments. FINDINGS: Participants randomized to the DBT condition evidenced a superior retention rate relative to their counterparts in the TAU condition at various study time points, including post-treatment (80% versus 20%) and follow-up (60% versus 20%). Due to the unexpected elevated dropout rates and the worsening of ED-SUD symptomatology in the TAU condition, recruitment efforts were terminated early. Results from the DBT condition revealed that the intervention had a significant positive effect on behavioural and attitudinal features of disordered eating, substance use severity and use, negative mood regulation and depressive symptoms. Finally, increases in participants' perceived ability to regulate and cope with negative emotional states were significantly associated with decreases in emotional eating and increases in levels of confidence in ability to resist urges for substance use. CONCLUSION: Results suggest that the adapted DBT might hold promise for treating individuals with concurrent ED and SUD. KEY PRACTITIONER MESSAGE: The current study is the first study to report positive effects of DBT on individuals with concurrent eating and substance use disorders. Although the results require replication and extension, they suggest that the DBT may be promising for this population. The results suggest that clinicians treating individuals with concurrent eating and substance use problems should be particularly cautious of poor treatment retention and treatment complications. The results bear upon the highly salient and important issue of whether individuals with concurrent substance use need to be excluded from research studies and treatment programmes.

Tenofovir and entecavir are the most effective antiviral agents for chronic hepatitis B: a systematic review and Bayesian meta-analyses.

BACKGROUND & AIMS: The relative efficacies of licensed antiviral therapies for treatment-naive chronic hepatitis B (CHB) infection in randomized controlled trials have not been determined. We evaluated the relative efficacies of the first 12 months of CHB treatments. METHODS: Drugs evaluated were lamivudine, pegylated interferon, adefovir, entecavir, telbivudine, and tenofovir, as monotherapies and combination therapies, in treatment-naive individuals. Databases were searched for randomized controlled trials of the first 12 months of therapy in hepatitis B e antigen (HBeAg)-positive and/or HBeAg-negative patients with CHB published in English before October 31, 2009. Bayesian mixed treatment comparisons were used to calculate the odds ratios, including 95% credible intervals and predicted probabilities of surrogate outcomes to determine the relative effects of each treatment. RESULTS: In HBeAg-positive patients, tenofovir was most effective in inducing undetectable levels of HBV DNA (predicted probability, 88%), normalization of alanine aminotransferase (ALT) levels (66%), HBeAg seroconversion (20%), and hepatitis B surface antigen loss (5%); it ranked third in histologic improvement of the liver (53%). Entecavir was most effective in improving liver histology (56%), second for inducing undetectable levels of HBV DNA (61%) and normalization of ALT levels (70%), and third in loss of hepatitis B surface antigen (1%). In HBeAg-negative patients, tenofovir was the most effective in inducing undetectable levels of HBV DNA (94%) and improving liver histology (65%); it ranked second for normalization of ALT levels (73%). CONCLUSIONS: In the first year of treatment for CHB, tenofovir and entecavir are the most potent oral antiviral agents for HBeAg-positive patients; tenofovir is most effective for HBeAg-negative patients.

Mindfulness-Action Based Cognitive Behavioral Therapy for concurrent Binge Eating Disorder and Substance Use Disorders.

Individuals with Binge Eating Disorder (BED) often evidence comorbid Substance Use Disorders (SUD), resulting in poor outcome. This study is the first to examine treatment outcome for this concurrent disordered population. In this pilot study, 38 individuals diagnosed with BED and SUD participated in a 16-week group Mindfulness-Action Based Cognitive Behavioral Therapy (MACBT). Participants significantly improved on measures of objective binge eating episodes; disordered eating attitudes; alcohol and drug addiction severity; and depression. Taken together, MACBT appears to hold promise in treating individuals with co-existing BED-SUD.

Suicide deaths by intentional self-poisoning in people with cardiovascular disease.

OBJECTIVE: We aimed to characterize self-poisoning deaths in people with cardiovascular disease (CVD) and compare to other suicide decedent groups. METHODS: Suicide deaths by self-poisoning in people with CVD (n = 151) were compared to suicide deaths by other methods in people with CVD (n = 260) and suicide deaths by self-poisoning in people without CVD (n = 509). Sub-analysis of the CVD self-poisoning group compared people with depression and without depression. Toxicology reports were compared between intentional self-poisoning groups. RESULTS: A higher proportion of suicide deaths were due to self-poisoning in the CVD group compared to the non-CVD group. People with CVD were less likely to have any identified stressor (excluding medical stressor) prior to dying from self-poisoning compared to those without CVD. Female sex, past suicide attempts, living circumstances, and comorbid substance abuse were each significantly associated with self-poisoning as the method of suicide in people with CVD. Opioid, any antidepressants, benzodiazepines, and tricyclic antidepressants (TCAs) were commonly identified as lethal in people with CVD. Compared to people in the CVD self-poisoning without depression group, people in the CVD self-poisoning with depression group were more likely to have lethal levels of TCAs. CONCLUSIONS: Our findings characterize suicide deaths in people with CVD, and identified notable differences based on method of death and presence of depression.

Did the suicide barrier work after all? Revisiting the Bloor Viaduct natural experiment and its impact on suicide rates in Toronto.

OBJECTIVE: This research aims to determine the long-term impact of the Bloor Street Viaduct suicide barrier on rates of suicide in Toronto and whether media reporting had any impact on suicide rates. DESIGN: Natural experiment. SETTING: City of Toronto, Canada; records at the chief coroner's office of Ontario 1993-2003 (11 years before the barrier) and 2004-2014 (11 years after the barrier). PARTICIPANTS: 5403 people who died by suicide in the city of Toronto. MAIN OUTCOME MEASURE: Changes in yearly rates of suicide by jumping at Bloor Street Viaduct, other bridges including nearest comparison bridge and walking distance bridges, and buildings, and by other means. RESULTS: Suicide rates at the Bloor Street Viaduct declined from 9.0 deaths/year before the barrier to 0.1 deaths/year after the barrier (incidence rate ratio (IRR) 0.005, 95% CI 0.0005 to 0.19, p=0.002). Suicide deaths from bridges in Toronto also declined significantly (IRR 0.53, 95% CI 0.40 to 0.71, p<0.0001). Media reports about suicide at the Bloor Street Viaduct were associated with an increase in suicide-by-jumping from bridges the following year. CONCLUSIONS: The current study demonstrates that, over the long term, suicide-by-jumping declined in Toronto after the barrier with no associated increase in suicide by other means. That is, the barrier appears to have had its intended impact at preventing suicide despite a short-term rise in deaths at other bridges that was at least partially influenced by a media effect. Research examining barriers at other locations should interpret short-term results with caution.

[A case of advanced pancreatic cancer treated with chemoradiation].

A 56-year-old man is presented with diarrhea, which he had experienced since February 2004. He was diagnosed as having advanced pancreatic cancer by enhanced abdominal CT scan in May 2004. He was diagnosed with unresectable pancreatic cancer, and treated with a combination of radiation (3 Gy/day) and injections of gemcitabine (GEM) 1,200 mg/week (800 mg/m2, BSA 1.6). Abdominal CT scan revealed a minor response (tumor diameter 5.7 x 4.8 --> 5.2 x 4.4). Accordingly, the improvement of performance status and reduction in serum levels of arcinoembryonic/carbohydrate antigen 19-9 (CA19-9) were observed. In July 2004, chemotherapy and radiotherapy were switched to GEM+UFT (UFT 360 mg/day, a total of 4,320 mg, GEM 1,200 mg according to the body mass, a total of 2,400 mg). The patient's performance state was stable for 6 months but serum levels of CA19-9 increased from March 2005, and he complained of diarrhea and back-pain. Therefore, the combination chemotherapy with GEM and cisplatin (CDDP) was started in April 2005, but there was no clinical effect. GEM and TS-1 are currently being administered. Pancreatic cancer is one of the worst prognoses of any malignant disease. Although the prognosis of unresectable pancreatic cancer is very poor, we presented a case where performance status and survival benefits were obtained by undergoing chemoradiation with GEM and combination chemotherapy with UFT and GEM.

Deep brain stimulation for treatment-resistant depression: follow-up after 3 to 6 years.

OBJECTIVE: A prevalence of at least 30% for treatment-resistant depression has prompted the investigation of alternative treatment strategies. Deep brain stimulation (DBS) is a promising targeted approach involving the bilateral placement of electrodes at specific neuroanatomical sites. Given the invasive and experimental nature of DBS for treatment-resistant depression, it is important to obtain both short-term and long-term effectiveness and safety data. This report represents an extended follow-up of 20 patients with treatment-resistant depression who received DBS to the subcallosal cingulate gyrus (Brodmann's area 25). METHOD: After an initial 12-month study of DBS, patients were seen annually and at a last follow-up visit to assess depression severity, functional outcomes, and adverse events. RESULTS: The average response rates 1, 2, and 3 years after DBS implantation were 62.5%, 46.2%, and 75%, respectively. At the last follow-up visit (range=3-6 years), the average response rate was 64.3%. Functional impairment in the areas of physical health and social functioning progressively improved up to the last follow-up visit. No significant adverse events were reported during this follow-up, although two patients died by suicide during depressive relapses. CONCLUSIONS: These data suggest that in the long term, DBS remains a safe and effective treatment for treatment-resistant depression. Additional trials with larger samples are needed to confirm these findings.