Buprenorphine Maintenance Treatment of Opiate Dependence: Correlations Between Prescriber Beliefs and Practices.

BACKGROUND: Despite the existence of evidence-based guidelines, different prescriber practices around buprenorphine maintenance treatment (BMT) of opiate dependence exist. Moreover, certain prescriber beliefs may influence their practice patterns. OBJECTIVE: To understand community BMT practice patterns and discern their relationship to practitioner beliefs. METHOD: Survey of 30 local BMT prescribers about aspects of BMT, and analysis of correlations between practices and practitioner beliefs. RESULTS: Practitioners generally followed standard treatment guidelines, though the most-common maintenance dosages of BMT (4-12 mg) were lower than recommended by some studies. Endorsement of belief in a "spiritual basis" of addiction correlated with lower average BMT doses and less frequent endorsement of the belief that BMT-treated patients are "in recovery." CONCLUSIONS/IMPORTANCE: These data suggest that relatively standardized, longer-term BMT of opiate dependence is accepted among the majority of surveyed prescribers, and certain provider beliefs about addiction may influence prescribing habits and attitudes. Future studies should: (1) assess these findings in larger samples; (2) examine how prescriber beliefs about addiction and BMT compare with those of other addiction treatment providers; and (3) ascertain whether individual prescriber beliefs influence patient outcomes.

Intramuscular ziprasidone: influence of alcohol and benzodiazepines on vital signs in the emergency setting.

BACKGROUND: Ziprasidone is a second-generation antipsychotic (SGA) approved for agitation. Few previous studies have examined ziprasidone in the emergency department (ED). For instance, it is unknown how often emergency physicians prescribe ziprasidone, whether it is typically prescribed in combination with a benzodiazepine, or whether use of intramuscular (i.m.) ziprasidone and benzodiazepines affects vital signs compared to i.m. ziprasidone alone. OBJECTIVE: Our aims were to determine the demographics of patients receiving ziprasidone in an urban-suburban ED; the relative frequency with which ziprasidone is prescribed; and the effects on vital signs, repeat medication dosage, and lengths of stay. METHODS: This is a multicentered structured chart review from 2003 to 2010 of ziprasidone use at two hospitals. If documented, vital signs were compared in patients who received concurrent benzodiazepines and in those who did not, and in patients who ingested alcohol and in those who did not. RESULTS: Patients on 95 visits received ziprasidone during the study period, with one third of these receiving accompanying benzodiazepines. Forty-nine unique patients who were treated with i.m. ziprasidone had documented vital signs. In these patients, alcohol intoxication was associated with decreased oxygen saturations irrespective of benzodiazepines. Concurrent benzodiazepines had no other deleterious effect on vital signs but resulted in longer ED stays. CONCLUSIONS: This study suggests that many ED physicians, who commonly prescribe a benzodiazepine with a first-generation antipsychotic like haloperidol, have transferred this practice to SGAs like ziprasidone. In this sample, this pairing did not adversely affect vital signs but was associated with marginally longer ED stays. Caution should be exercised when treating alcohol-intoxicated patients with ziprasidone, as this can decrease oxygen saturations.

A naturalistic study of intramuscular haloperidol versus intramuscular olanzapine for the management of acute agitation.

OBJECTIVE: Published research on agitation is limited by the difficulty in generalizing findings from trials using moderately agitated, carefully selected patients treated with single agents. More specifically, there are few comparative studies examining common intramuscular (IM) regimens (ie, haloperidol with or without benzodiazepines) with IM atypical antipsychotics. Therefore, we conducted a retrospective chart review to compare IM olanzapine and haloperidol in a "real-world" population with agitation. METHOD: We performed a retrospective evaluation of charts from 146 consecutive emergency department patients who received either IM haloperidol or IM olanzapine for agitation. We used a clinically oriented proxy marker of efficacy--the necessity for additional medication intervention for agitation (AMI)--as our primary outcome measure. RESULTS: Additional medication intervention for agitation was required by 43% (13/30) patients when haloperidol was given alone and by 18% (13/72) when haloperidol was given with a benzodiazepine. In the case of olanzapine, AMI was required by 29% (6/21) of patients receiving olanzapine alone and by 18% (2/11) of patients given olanzapine plus a benzodiazepine. A significant percentage of patients had clinical characteristics (nonpsychiatric triage complaint, drug/alcohol use, severe agitation) that differ from more selective samples. CONCLUSIONS: Overall, these finding suggest that in a naturalistic emergency department setting, haloperidol monotherapy is less effective--at least in requiring AMI--than olanzapine with or without a benzodiazepine or haloperidol plus a benzodiazepine. Moreover, these later 3 regimens seemed comparable. Prospective studies examining the treatment of real-world agitation, including head-to-head comparisons of the haloperidol-benzodiazepine combination with newer IM antipsychotics, are needed.

Dramatic improvement in sexual function induced by intranasal oxytocin.

INTRODUCTION: A variety of sources indicate that oxytocin has beneficial effects on several components of sexuality. This is a case report on a male who had significant, broad-spectrum improvements in sexual function during a course of intranasal oxytocin treatment for social anxiety. AIM: To document a case of diverse, salutary effects of oxytocin on sexual function. METHODS: The patient was in individual treatment for a variety of difficulties, including social avoidance and relational problems. A biopsychosocial evaluation ruled out medical conditions and substance-related issues as a cause of sexual difficulties. After obtaining informed consent, an off-label trial of intranasal oxytocin was administered targeting his social anxiety and relational avoidance. RESULTS: Oxytocin positively impacted a number of components of sexual function, including libido, erection, and orgasm, and was well tolerated. CONCLUSIONS: This is the first case we are aware of documenting broad-spectrum benefits of chronic intranasal oxytocin on male sexual function. Future trials of oxytocin for psychiatric indications should specifically monitor its effects on sexuality, and trials directly investigating oxytocin's impact on aspects of sexual function are warranted.

Olanzapine in ED patients: differential effects on oxygenation in patients with alcohol intoxication.

INTRODUCTION: Agitation has significant consequences for patients and staff. When verbal techniques fail, expert guidelines recommend the use of second-generation antipsychotics (SGAs). Perhaps out of familiarity with haloperidol and benzodiazepines, emergency department (ED) clinicians often pair SGAs with benzodiazepines as well. Use of SGAs such as olanzapine in alcohol-intoxicated (ETOH+) patients or with benzodiazepines is not well studied and may be associated with vital sign abnormalities. METHODS: This is a structured chart review of all patient visits who received either oral or intramuscular (i.m.) olanzapine in an academic ED from 2004 to 2010 and who had systolic blood pressure, heart rate, and oxygen saturation documented before medication administration and within 4 hours afterwards. RESULTS: Four hundred eighty-two patient visits received olanzapine; 275 patient visits (225 oral, 50 i.m.) had vital signs documented. Neither route of administration, concurrent benzodiazepines, nor ingestion of ETOH were associated with significant decreases in systolic BP or heart rate (P = ns for all comparisons). Decreases in oxygen saturations, however, were significantly larger in ETOH+ patients who received i.m. olanzapine or i.m. olanzapine + benzodiazepines. Route of administration, concurrent benzodiazepines, nor ingestion of ETOH was associated with significant decreases in systolic blood pressure or heart rate (p = ns for all comparisons). Decreases in oxygen saturations, however, were significantly larger in ETOH+ patients who received i.m. olanzapine or i.m. olanzapine + benzodiazepines. CONCLUSIONS: Oral olanzapine was not associated with significant vital sign changes in ED patients. Intramuscular olanzapine also was not associated with vital sign changes in ETOH- patients. In ETOH+ patients, i.m. olanzapine was associated with significant oxygen desaturations. In ETOH+ ED patients, oral olanzapine (with or without benzodiazepines) or haloperidol may be safer choices. ETOH+ patients may have differential effects with the use of i.m. SGAs such as olanzapine and should be studied separately in drug trials.

Potential complications of combining intramuscular olanzapine with benzodiazepines in emergency department patients.

BACKGROUND: Olanzapine (Eli Lilly and Company, Indianapolis, IN) is starting to be used with more frequency in emergency departments (EDs) for agitated patients. The potential complications of the use of olanzapine in combination with a benzodiazepine have not been well characterized in ED patients with undifferentiated agitation. OBJECTIVES: The measurement of vital signs, repeat medication dosage, and ethanol levels in patients who received parenteral (intramuscular [IM]) olanzapine either alone or concurrently with benzodiazepines. METHODS: This is a structured retrospective chart review of all patients who met the criteria of having received IM olanzapine for agitation and having vital signs documented both before medication administration and within 4 h afterwards. RESULTS: Twenty-five patients were identified as meeting the inclusion criteria. Ten patients received olanzapine and benzodiazepine, and 15 patients received olanzapine alone. Regardless of whether or not they received benzodiazepines, patients who had ingested significant amounts of alcohol before arrival in the ED had decreased oxygen saturations after olanzapine administration. Oxygen saturations decreased more in patients who had ingested alcohol and then received olanzapine + benzodiazepines. Two patients (20%) who received olanzapine + benzodiazepines and who had ingested significant amounts of alcohol exhibited hypoxia, defined as lowest O(2) saturation ≤ 92%. CONCLUSIONS: In this relatively small sample, olanzapine plus benzodiazepines seems to be safe in patients who have not ingested alcohol, but may produce potentially significant oxygen desaturations in patients who have. Future, prospective studies should explore the benefits vs. potential risks of adding a benzodiazepine to olanzapine for agitated patients in the ED.

A comparison of the safety of olanzapine and haloperidol in combination with benzodiazepines in emergency department patients with acute agitation.

BACKGROUND: Pharmacologic management of the agitated emergency department patient is controversial. The combination of olanzapine + benzodiazepines is not recommended by the manufacturer, but a recent report suggested harm only if the patient was intoxicated. Whether this is also true for haloperidol + benzodiazepines is not known. OBJECTIVES: The measurement of vital signs and ethanol levels in patients who received haloperidol with or without benzodiazepines was compared to a previous analysis of patients who received olanzapine with or without benzodiazepines. METHODS: This is a structured retrospective chart review of patients who received parenteral haloperidol or parental olanzapine either with or without benzodiazepines. RESULTS: There were 96 patients (71 haloperidol, 25 olanzapine) who met inclusion criteria. No patient in the olanzapine + benzodiazepine group had hypotension, although one patient in the olanzapine-only group did (6.7%); 2 patients in the haloperidol + benzodiazepines group (5.1%) and 2 patients in the haloperidol-only group (6.3%) had hypotension. In alcohol-negative (ETOH-) patients, neither olanzapine alone nor olanzapine + benzodiazepines was associated with decreased oxygen saturations. In ETOH+ patients, olanzapine alone was not associated with decreased oxygen saturations, but olanzapine + benzodiazepines were associated with lower oxygen saturations than haloperidol + benzodiazepines. CONCLUSIONS: In this sample, olanzapine alone or with a benzodiazepine was not associated with more hypotension than haloperidol. However, olanzapine + benzodiazepines were associated with lower oxygen saturations than haloperidol + benzodiazepines in ETOH+ but not ETOH- patients. In patients with known alcohol ingestion, haloperidol, haloperidol + benzodiazepines, or olanzapine alone may be better choices for treatment of agitation.

Peas, please: a case report and neuroscientific review of dissociative amnesia and fugue.

Dissociative amnesia that encompasses one's entire life and identity is a rare disorder, as is dissociative fugue. In evaluating such cases, a dichotomy is often invoked between functional and organic etiologies. However, this dichotomy suffers from both conceptual and ethical flaws. Conceptually, putative brain-based, organic etiologies for many dissociative disorders-including dissociative amnesia-exist. Ethically, such dichotomies may result in dismissive care for patients with distress-based disorders like dissociative amnesia. In support of humane, neurobiologically informed treatment of patients with dissociative amnesia, we present excerpts from 2 post-event interviews with a patient who suffered and recovered from an episode of dissociative amnesia and fugue. Following this, we review current neurobiological models of dissociative amnesia that undermine the dichotomy of functional versus organic, and suggest that the crucial distinction in such cases is between a patient's willful, conscious deceit and processes that occur without conscious intent.

WHY NOT POT?: A Review of the Brain-based Risks of Cannabis.

In this review, we provide a historical perspective on marijuana, and survey contemporary research investigating its potential negative effects on the brain. We discuss the evidence regarding cannabis dependence, driving under the influence of cannabis, underachievement, inducing (or worsening) certain psychiatric conditions, and the potential for progression to use of more dangerous drugs-summarized by the acronym DDUMB, a cognitive tool that may help healthcare providers in their risk/benefit discussions with patients who use cannabis. We also review and discuss the impact of marijuana use on target populations, including adolescents (who are at increased risk of harm); heavy users; and people suffering from-or at high risk of- mental illness. While cannabis presents certain subjective, healthrelated, and pecuniary benefits to users, growers, and other entities, it is also associated with several brainbased risks. Understanding these risks aids clinicians and their patients in making informed and balanced decisions regarding the initiation or continuance of marijuana use.

A Review of Oxytocin's Effects on the Positive, Negative, and Cognitive Domains of Schizophrenia.

Schizophrenia is a disabling, heterogeneous disorder with clinical features that can be parsed into three domains: positive symptoms, negative symptoms, and cognitive deficits. Current antipsychotic drugs produce fairly robust clinical benefit against positive symptoms but typically have minimal therapeutic effects on negative symptoms and cognitive deficits. Oxytocin (OT) is a nonapeptide that, in addition to its role as a hormone regulating peripheral reproductive-relevant functions, acts as a neurotransmitter in the brain. Several lines of preclinical and clinical research suggest that the OT system may play a role in regulating the expression of schizophrenia spectrum disorders and that targeting the central OT system may yield novel treatments to address these symptoms. In this review, we summarize the extant preclinical and clinical evidence relevant to the role of OT in schizophrenia with particular emphasis on its putative therapeutic effects on each of the three above-mentioned clinical domains.

Minimization of Childhood Maltreatment Is Common and Consequential: Results from a Large, Multinational Sample Using the Childhood Trauma Questionnaire.

Childhood maltreatment has diverse, lifelong impact on morbidity and mortality. The Childhood Trauma Questionnaire (CTQ) is one of the most commonly used scales to assess and quantify these experiences and their impact. Curiously, despite very widespread use of the CTQ, scores on its Minimization-Denial (MD) subscale-originally designed to assess a positive response bias-are rarely reported. Hence, little is known about this measure. If response biases are either common or consequential, current practices of ignoring the MD scale deserve revision. Therewith, we designed a study to investigate 3 aspects of minimization, as defined by the CTQ's MD scale: 1) its prevalence; 2) its latent structure; and finally 3) whether minimization moderates the CTQ's discriminative validity in terms of distinguishing between psychiatric patients and community volunteers. Archival, item-level CTQ data from 24 multinational samples were combined for a total of 19,652 participants. Analyses indicated: 1) minimization is common; 2) minimization functions as a continuous construct; and 3) high MD scores attenuate the ability of the CTQ to distinguish between psychiatric patients and community volunteers. Overall, results suggest that a minimizing response bias-as detected by the MD subscale-has a small but significant moderating effect on the CTQ's discriminative validity. Results also may suggest that some prior analyses of maltreatment rates or the effects of early maltreatment that have used the CTQ may have underestimated its incidence and impact. We caution researchers and clinicians about the widespread practice of using the CTQ without the MD or collecting MD data but failing to assess and control for its effects on outcomes or dependent variables.

A perfect childhood? Clinical correlates of minimization and denial on the childhood trauma questionnaire.

Childhood trauma has pervasive and enduring effects on myriad health outcomes, and the Childhood Trauma Questionnaire (CTQ) is a widely used screening tool. To assess recall and reporting biases, the CTQ includes a Minimization/Denial (MD) Scale, although this scale is typically omitted or not reported on. As this practice is not supported by empirical data, we sought to examine the clinical correlates of the CTQ MD Scale, as well as its function as a response bias index (i.e., its moderation effects). We examined correlations between the MD Scale and attachment style, temperament, personality, depression, and clinical diagnoses in a group of 200 adult psychiatric outpatients. Regression analyses were performed to assess the impact of MD on the relationships between the CTQ and clinical variables. Twenty percent of our sample met MD criteria. When patients were grouped as MD-positive versus MD-negative, significant between-group differences were found on several clinical measures. MD status, however, did not significantly moderate the relationships between the CTQ and clinical variables. This is one of the first clinically focused examinations of the CTQ's MD Scale. Although the MD Scale was associated with several clinical variables, it did not significantly moderate the relationship between the CTQ and clinical variables. These findings, therefore, call into question the value of the MD Scale as a response bias index, although they should be replicated in larger studies before the currently ubiquitous practice of ignoring it can be considered evidence-based.

Individual risk factors for physician boundary violations: the role of attachment style, childhood trauma and maladaptive beliefs.

OBJECTIVE: The assessment and remediation of boundary-challenged healthcare professionals is enhanced through examination of individual risk factors. We assessed three such factors--attachment style, childhood trauma and maladaptive beliefs--in 100 attendees (mostly physicians) of a CME professional boundaries course. We propose a theoretical model which draws a causal arc from childhood maltreatment through insecure attachment and maladaptive beliefs to elevated risk for boundary violations. METHODS: We administered the Experiences in Close Relationship Questionnaire (ECR-R), Childhood Trauma Questionnaire (CTQ), and Young Schema Questionnaire (YSQ) to 100 healthcare professionals (mostly physicians) attending a CME course on professional boundaries. Experts rated participant autobiographies to determine attachment style and early adversities. Correlations and relationships among self- and expert ratings and between different risk factors were examined. RESULTS: Five percent of participants reported CTQ total scores in the moderate to severe range; eleven percent reported moderate to severe emotional neglect or emotional abuse. Average attachment anxiety and attachment avoidance were low, and more than half of participants were rated "secure" by experts. Childhood maltreatment was correlated with attachment anxiety and avoidance and predicted expert-rated insecure attachment and maladaptive beliefs. CONCLUSION: Our findings support a potential link between childhood adversity and boundary difficulties, partly mediated by insecure attachment and early maladaptive beliefs. Furthermore, these results suggest that boundary education programs and professional wellness programs may be enhanced with a focus on sequelae of childhood maltreatment, attachment and common maladaptive thinking patterns.

Individual risk factors for physician boundary violations: the role of attachment style, childhood trauma and maladaptive beliefs.

OBJECTIVE: The assessment and remediation of boundary-challenged health care professionals is enhanced through examination of individual risk factors. We assessed three such factors - attachment style, childhood trauma and maladaptive beliefs - in 100 attendees (mostly physicians) of a continuing medical education (CME) professional boundaries course. We propose a theoretical model that draws a causal arc from childhood maltreatment through insecure attachment and maladaptive beliefs to elevated risk for boundary violations. METHODS: We administered the Experiences in Close Relationships Questionnaire Revised (ECR-R), Childhood Trauma Questionnaire (CTQ) and Young Schema Questionnaire (YSQ) to 100 health care professionals attending a CME course on professional boundaries. Experts rated participant autobiographies to determine attachment style and early adversities. Correlations and relationships between self-ratings and expert ratings and among different risk factors were examined. RESULTS: One fifth of participants reported moderate to severe childhood abuse; sixty percent reported moderate to severe emotional neglect. Despite this, average attachment anxiety and attachment avoidance were low, and more than half of participants were rated "secure" by experts. Childhood maltreatment was correlated with attachment anxiety and avoidance and predicted expert-rated insecure attachment and maladaptive beliefs. CONCLUSIONS: Our findings support a potential link between childhood adversity and boundary difficulties, partly mediated by insecure attachment and early maladaptive beliefs. Furthermore, these results suggest that boundary education programs and professional wellness programs may be enhanced with a focus on sequelae of childhood maltreatment, attachment and common maladaptive thinking patterns.

Oxytocin's role in anxiety: a critical appraisal.

A growing literature suggests that the oxytocin (OT) system may play a role in human anxiety states, anxiety-related traits, and moreover, that this system may be a target for the development of novel anxiolytic treatments. However, studies of OT's acute and chronic effects on various aspects of anxiety have produced mixed results. In this forward-looking review, we discuss the myriad phenomena to which the term "anxiety" is applied in the OT literature and the problem this presents developing a coherent picture of OT's role in anxiety. We then survey several different fields of research that support the role of the OT system in human anxiety, including evolutionary perspectives, translational and neuroimaging research, genetic studies, and clinical trials of intranasal OT. As an outgrowth of this data, we propose a "bowtie" model of OT's role at the interface of social attachment and anxiety. We next direct attention to understudied brain regions and neural circuits which may be important to study in OT experiments in humans anxiety disorders. Finally, we conclude by proposing questions and priorities for studying both the clinical potential of OT in anxiety, as well as mechanisms that may underlie this potential. Crucially, these priorities include targeted proof-of-concept clinical trials of IN OT in certain anxiety disorders, including investigations of individual moderators of OT's anxiolytic effects (i.e. sex, genetic factors, and early experience). This article is part of a Special Issue entitled Oxytocin and Social Behav.

Hormones as "difference makers" in cognitive and socioemotional aging processes.

Aging is associated with well-recognized alterations in brain function, some of which are reflected in cognitive decline. While less appreciated, there is also considerable evidence of socioemotional changes later in life, some of which are beneficial. In this review, we examine age-related changes and individual differences in four neuroendocrine systems-cortisol, estrogen, testosterone, and oxytocin-as "difference makers" in these processes. This suite of interrelated hormonal systems actively coordinates regulatory processes in brain and behavior throughout development, and their level and function fluctuate during the aging process. Despite these facts, their specific impact in cognitive and socioemotional aging has received relatively limited study. It is known that chronically elevated levels of the stress hormone cortisol exert neurotoxic effects on the aging brain with negative impacts on cognition and socioemotional functioning. In contrast, the sex hormones estrogen and testosterone appear to have neuroprotective effects in cognitive aging, but may decrease prosociality. Higher levels of the neuropeptide oxytocin benefit socioemotional functioning, but little is known about the effects of oxytocin on cognition or about age-related changes in the oxytocin system. In this paper, we will review the role of these hormones in the context of cognitive and socioemotional aging. In particular, we address the aforementioned gap in the literature by: (1) examining both singular actions and interrelations of these four hormonal systems; (2) exploring their correlations and causal relationships with aspects of cognitive and socioemotional aging; and (3) considering multilevel internal and external influences on these hormone systems within the framework of explanatory pluralism. We conclude with a discussion of promising future research directions.

Attachment, affective temperament, and personality disorders: a study of their relationships in psychiatric outpatients.

BACKGROUND: As the result of extensive translational and cross-disciplinary research, attachment theory is now a construct with significant neuropsychiatric traction. The correlation of attachment with other influential conceptual models (i.e. temperament and personality) is therefore of interest. Consequently, we explored how two attachment dimensions (attachment anxiety and attachment avoidance) correlated with measures of temperament and personality in 357 psychiatric outpatients. METHODS: We performed a retrospective review of four questionnaires (the Experiences in Close Relationship scale (ECR-R), Temperament and Character inventory (TCI), Temperament Evaluation of the Memphis, Pisa, Paris and San Diego questionnaire (TEMPS-A), and Personality Self-Portrait Questionnaire (PSQ)). Frequency measures and correlations were examined, as was the predictive value of attachment security for a personality disorder (PD). RESULTS: Significant, robust correlations were found between attachment anxiety and (1) several negative affective temperaments (dysthymic and cyclothymic); (2) several indices of personality pathology (low self-directedness (TCI), DSM-IV paranoid, borderline, histrionic, avoidant and dependent personality traits). Attachment avoidance had fewer large correlations. In an exploratory model, the negative predictive value of attachment security for a PD was 86%. LIMITATIONS: Subjects were a relatively homogeneous subset of ambulatory psychiatric outpatients. PD diagnoses were via self-report. CONCLUSIONS: Clinically, these findings highlight the significant overlap between attachment, affective temperament, and personality and support the value of attachment as a screen for PDs. More broadly, given our growing understanding of the neurobiology of attachment (i.e. links with the oxytocin system), these results raise interesting questions about underlying biological systems and psychiatric treatment.

Psychometric properties of the Childhood Trauma Questionnaire-Short Form (CTQ-SF) in Korean patients with schizophrenia.

OBJECTIVE: Despite increasing interest in the relationship between childhood trauma and psychosis, measures used to assess early trauma have not had their psychometric properties extensively tested among individuals with serious mental illness. This study investigated the reliability and validity of one of the most widely-used self-reports of early adversity, the Childhood Trauma Questionnaire, Short Form (CTQ), among patients with schizophrenia. METHODS: The CTQ was administered to 100 patients (52 inpatients and 48 outpatients) diagnosed with schizophrenia in three training hospitals. Internal consistency, four-week test-retest reliability and validity were calculated. Participants also completed the Trauma Antecedents Questionnaire (TAQ), the Impact of Events Scale-Revised (IES-R), and the Dissociative Experiences Scale-Taxon (DES-T). RESULTS: Our analysis indicated high test-retest reliability (Spearman ρ=0.75) and internal consistency (Cronbach α=0.89). Concurrent validity was confirmed as each type of childhood trauma was significantly correlated with the corresponding subscales of the TAQ. In addition, the CTQ was positively related to post-traumatic stress symptoms and pathological dissociation, demonstrating the convergent validity of the scale. CONCLUSION: The CTQ is a reliable and valid self-report measure for assessing childhood trauma in both inpatients and outpatients with schizophrenia.

Oxytocin and socioemotional aging: Current knowledge and future trends.

The oxytocin (OT) system is involved in various aspects of social cognition and prosocial behavior. Specifically, OT has been examined in the context of social memory, emotion recognition, cooperation, trust, empathy, and bonding, and-though evidence is somewhat mixed-intranasal OT appears to benefit aspects of socioemotional functioning. However, most of the extant data on aging and OT is from animal research and human OT research has focused largely on young adults. As such, though we know that various socioemotional capacities change with age, we know little about whether age-related changes in the OT system may underlie age-related differences in socioemotional functioning. In this review, we take a genetic-neuro-behavioral approach and evaluate current evidence on age-related changes in the OT system as well as the putative effects of these alterations on age-related socioemotional functioning. Looking forward, we identify informational gaps and propose an Age-Related Genetic, Neurobiological, Sociobehavioral Model of Oxytocin (AGeNeS-OT model) which may structure and inform investigations into aging-related genetic, neural, and sociocognitive processes related to OT. As an exemplar of the use of the model, we report exploratory data suggesting differences in socioemotional processing associated with genetic variation in the oxytocin receptor gene (OXTR) in samples of young and older adults. Information gained from this arena has translational potential in depression, social stress, and anxiety-all of which have high relevance in aging-and may contribute to reducing social isolation and improving well-being of individuals across the lifespan.

Oxytocin and psychotherapy: a pilot study of its physiological, behavioral and subjective effects in males with depression.

Individual psychotherapy is an important treatment for a number of psychiatric conditions and involves a unique form of human attachment. This raises the question of whether oxytocin (OT), the paradigmatic "attachment hormone", may have benefits in this context. In this randomized, double-blind, crossover trial, we gave male psychiatric outpatients with major depressive disorder 40 IU intranasal OT or placebo before a videotaped session with a therapist and measured a number of subjective, physiological, and behavioral parameters. We report three main findings. Surprisingly - in contrast to prior reports of OT's anxiolytic properties - we found OT caused an increase in anxiety over the course of the therapy session. Secondly, though it had no main effect on cortisol, eye contact, or overall behavior, we did find that OT caused a decrease in nonverbal behaviors that cut off social contact, after controlling for level of depressive symptoms. Lastly, we replicated prior findings that OT improves social cognition (performance on the reading the mind in the eyes test (RMET)), albeit in a depressed patient group. These results inform future studies of oxytocin and psychotherapy and suggest that in certain clinical populations and contexts, OT has heterogeneous subjective effects which may include acute anxiogenesis. Moreover, the similarity of some of these acute effects to those of single-dose serotonergic antidepressants raises interesting questions about the potential antidepressant benefits of chronic OT administration.