Virtual Reality-Based Simulated Hallucinations to Enhance Empathy Toward Individuals With Schizophrenia.

ABSTRACT: Individuals affected by schizophrenia often relay frustration that persons in their life are unable to understand their symptoms. We sought to examine whether a brief virtual reality (VR) experience for students in an undergraduate psychopathology course entailing simulated hallucinations could increase empathy, decrease negative affect, and positively affect attitudes toward persons with schizophrenia. After the unit on schizophrenia, 41 participants engaged in a VR experience with simulated auditory and visual hallucinations. We sought to maximize fidelity and immersion by incorporating the actual classroom and course instructor into the virtual world. By collecting data at multiple points, we were able to isolate the impact of the simulation on affect and attitudes. Participants experienced an increase in empathy and favorable attitudes toward individuals with schizophrenia and reported the simulation to be highly educational. The favorable results are notable given the brevity of the simulation and the absence of any explicit (declarative) knowledge being conveyed.

Olfaction evaluation in dogs with sudden acquired retinal degeneration syndrome.

PURPOSE: To evaluate olfaction in dogs with sudden acquired retinal degeneration syndrome (SARDS) compared with sighted dogs and blind dogs without SARDS as control groups. ANIMALS STUDIED: Forty client-owned dogs. PROCEDURE: Olfactory threshold testing was performed on three groups: SARDS, sighted, and blind/non-SARDS using eugenol as the test odorant. The olfactory threshold was determined when subjects indicated the detection of a specific eugenol concentration with behavioral responses. Olfactory threshold, age, body weight, and environmental room factors were evaluated. RESULTS: Sixteen dogs with SARDS, 12 sighted dogs, and 12 blind/non-SARDS dogs demonstrated mean olfactory threshold pen numbers of 2.8 (SD = 1.4), 13.8 (SD = 1.4), and 13.4 (SD = 1.1), respectively, which correspond to actual mean concentrations of 0.017 g/mL, 1.7 × 10-13 g/mL and 4.26 × 10-13 g/mL, respectively. Dogs with SARDS had significantly poorer olfactory threshold scores compared with the two control groups (p < .001), with no difference between the control groups (p = .5). Age, weight, and room environment did not differ between the three groups. CONCLUSIONS: Dogs with SARDS have severely decreased olfaction capabilities compared with sighted dogs and blind/non-SARDS dogs. This finding supports the suspicion that SARDS is a systemic disease causing blindness, endocrinopathy, and hyposmia. Since the molecular pathways are similar in photoreceptors, olfactory receptors, and steroidogenesis with all using G-protein coupled receptors in the cell membrane, the cause of SARDS may exist at the G-protein associated interactions with intracellular cyclic nucleotides. Further investigations into G-protein coupled receptors pathway and canine olfactory receptor genes in SARDS patients may be valuable in revealing the cause of SARDS.

The paradoxical association between tension-reduction alcohol outcome expectancies and tension following alcohol consumption.

Background: Behavioral models suggest that strong tension-reduction alcohol-outcome expectancies (TREs) among drinkers should be associated with greater tension reduction after drinking. Yet, the few studies investigating this have found either no relationship or the opposite relationship.Objectives: We sought to explore this relationship by building upon the limitations of past studies and employing a placebo-controlled, within-subject experimental design.Methods: Sixty social drinkers (26 M, 34 F) visited the lab on two occasions spaced one week apart. Each participant was randomly assigned to receive alcoholic drinks targeting a BAC of 0.05% on one testing day and placebo drinks on the other, with the order counter-balanced. On both testing days, participants completed measures of state anxiety and fear both before drinking and following a drinking/absorption period. While completing the self-report measures, participants were anticipating an impending, mildly stressful heartbeat perception task.Results: Multilevel modeling revealed that the more strongly individuals believed that alcohol reduces tension, the less the pharmacologic properties of alcohol did so (p = .02 for the state anxiety outcome measure; p = .001 for the fear outcome measure). This was the case even with anxiety sensitivity - a known predictor of stress-response dampening - controlled for.Conclusions: These results provide further evidence for the paradoxical association of TREs and the dampening of anxiety. Additionally, the findings are consistent with the basis of expectancy challenges that aim to reframe inaccurate TREs among drinkers.

Clinimetric properties of the Smoking Abstinence Expectancies Questionnaire.

Smoking abstinence expectancies are beliefs about negative and positive short-term psychological and physiological consequences of not smoking. The Smoking Abstinence Expectancies Questionnaire (SAEQ) is a widely used Patient-Reported Outcome Measure (PROM) to assess smoking abstinence expectancies. It has four subscales: negative mood, somatic symptoms, harmful consequences, positive consequences. Although studied from a psychometric perspective, the SAEQ needs further evaluation. Clinimetrics, and its Clinimetric Criteria for Patient-Reported Outcome Measures (CLIPROM), offers a robust method to evaluate the SAEQ. We verified construct validity and sensitivity of the Italian version of the SAEQ applying CLIPROM criteria. A total of 293 adult Italian smokers were consecutively enrolled at two smoking cessation clinics and assessed via the SAEQ. Item Response Theory models (i.e., combining Rasch and Mokken analyses) were used to test construct validity and sensitivity. The total score of the SAEQ was not found to be unidimensional but each SAEQ subscale score was. PSI (0.90) indicated that the total score of the SAEQ could reliably discriminate between respondents with different levels of the trait under assessment, whereas SAEQ subscales on negative mood and harmful consequences could reliably distinguish between different groups but not between different subjects (PSI ranging from 0.77 and 0.78). Overall, the total score of the SAEQ is a sensitive screening PROM and can be used at smoking cessation clinics to discriminate between subjects with different levels of smoking abstinence expectancies. SAEQ subscales should be used to detect severity and subjective burden of a wide range of expected effects of nicotine abstinence.

The effects of alcohol on heartbeat perception: Implications for anxiety.

INTRODUCTION: It is well established that some individuals self-medicate their anxiety with alcohol. Though much evidence exists that alcohol consumption can be negatively reinforcing, there remains uncertainty regarding what mediates the relationship between alcohol and anxiety. An unexplored possibility is that, for some, alcohol impairs interoceptive sensitivity (the ability to accurately perceive one's physiological state), thereby decreasing state anxiety. Consistent with this, highly accurate heartbeat perception is a risk factor both for elevated trait anxiety and anxiety disorders. However, the direct impact of alcohol on cardioceptive accuracy has not to our knowledge been previously examined. METHODS: Sixty-one social drinkers came to the lab in groups of 4-6 on two days spaced a week apart. Each participant was randomly assigned to receive alcoholic drinks targeting a BAC of 0.05% on one testing day and placebo drinks on the other, with the order counter-balanced. On both testing days, participants engaged in a Schandry heartbeat perception task on three occasions: at baseline, after an alcohol absorption period, and after physiological arousal was raised via exercise. RESULTS: For men only, alcohol significantly impaired cardioceptive accuracy relative to a placebo at both low and high levels of arousal, with medium to large effect sizes. CONCLUSIONS: Though preliminary, this finding is consistent with the proposed hypothesis linking alcohol consumption and anxiety, at least for men. Future studies should directly examine whether, among individuals with anxiety disorders, cardioceptive sensitivity mediates the relationship between alcohol consumption and state anxiety.

Nicotine deprivation attenuates panic reactivity in smokers: Findings from a placebo-controlled nicotine patch study.

BACKGROUND: Prospective studies consistently find that smoking is a risk factor for the development of panic disorder (PD). A possible explanation is that nicotine deprivation promotes heightened sensitivity to bodily sensations and/or arterial carbon dioxide (CO2 ). Abrams et al. (2011) previously found that, in response to a CO2 rebreathing challenge, smokers experiencing more (vs. less) intense nicotine withdrawal had more severe panic symptoms and a stronger urge to escape. However, participants were aware of the last time they smoked, leaving unclear the extent to which fear reactivity was influenced by the pharmacologic effects of nicotine deprivation versus beliefs regarding when nicotine was most recently used. The present study aimed to ascertain whether nicotine deprivation, independent of beliefs regarding recent nicotine use, promotes fear reactivity among smokers. METHODS: Moderate to heavy smokers without PD (N = 25) participated in a placebo-controlled, double-blind study consisting of two sessions spaced 1 week apart. Participants abstained from nicotine for 2 hr prior to sessions. During one session participants were given a 21 mg nicotine replacement patch and, during the other, a placebo patch, with the order counterbalanced. For both sessions, after a 3-hr absorption period, participants underwent a 10-min CO2 rebreathing challenge. RESULTS: Wearing a nicotine (vs. placebo) patch increased self-reported panic reactivity among participants, but did not significantly affect physiological and behavioral measures of reactivity. CONCLUSIONS: In smokers without a history of PD, nicotine deprivation attenuates subjective panic reactivity. Possible explanations for the contrast between theory and laboratory findings as well as clinical implications are discussed.

Sudden acquired retinal degeneration in dogs: breed distribution of 495 canines.

PURPOSE: The purpose of this study was to describe breed, age, gender, and weight distribution of dogs affected with sudden acquired retinal degeneration (SARD) and to investigate whether SARD is more common in small breed dogs. METHODS: Medical records of dogs diagnosed with SARD confirmed by an electroretinogram were reviewed. Breed, age, gender, and weight were recorded when available. The same data were obtained for dogs with SARD described in the veterinary literature. RESULTS: Three hundred and two dogs were included from the ophthalmology practices and 193 dogs from the veterinary literature. Sixty breeds were present in the study. Mixed-breed dogs were the most common at 108 dogs (21.8%), followed by the Dachshund (68, 13.7%), Chinese Pug (44, 8.9%), Miniature Schnauzer (39, 7.9%), Maltese (23, 4.6%), Cocker Spaniel (22, 4.4%), Bichon Frise (18, 3.6%), Beagle (16, 3.2%), Brittany (15, 3.0%), and Pomeranian (10, 2.0%). Fifty other breeds were represented by 1-9 dogs each. The median age was 9 years (range = 10 months-16 years). The weight was known for 197 dogs. About 60.9% of dogs were less than 25 pounds, 31.5% were between 25 and 50 pounds, and 7.6% were greater than 50 pounds. Gender was recorded in 393 dogs: 217 female dogs and 176 male dogs. CONCLUSIONS: As previously reported, SARD is most common in middle-aged to older dogs. Smaller dogs of less than 25 pounds appear overrepresented, while large/giant breed dogs of greater than 50 pounds are infrequently diagnosed. In this study, there was no statistical significance between female and male dogs.

Sudden acquired retinal degeneration syndrome (SARDS) - a review and proposed strategies toward a better understanding of pathogenesis, early diagnosis, and therapy.

Sudden acquired retinal degeneration syndrome (SARDS) is one of the leading causes of currently incurable canine vision loss diagnosed by veterinary ophthalmologists. The disease is characterized by acute onset of blindness due to loss of photoreceptor function, extinguished electroretinogram with an initially normal appearing ocular fundus, and mydriatic pupils which are slowly responsive to bright white light, unresponsive to red, but responsive to blue light stimulation. In addition to blindness, the majority of affected dogs also show systemic abnormalities suggestive of hyperadrenocorticism, such as polyphagia with resulting obesity, polyuria, polydipsia, and a subclinical hepatopathy. The pathogenesis of SARDS is unknown, but neuroendocrine and autoimmune mechanisms have been suggested. Therapies that target these disease pathways have been proposed to reverse or prevent further vision loss in SARDS-affected dogs, but these treatments are controversial. In November 2014, the American College of Veterinary Ophthalmologists' Vision for Animals Foundation organized and funded a Think Tank to review the current knowledge and recently proposed ideas about disease mechanisms and treatment of SARDS. These panel discussions resulted in recommendations for future research strategies toward a better understanding of pathogenesis, early diagnosis, and potential therapy for this condition.

Effects of nicotine withdrawal on panic-like response to breath holding: a placebo-controlled, double-blind, crossover patch study.

BACKGROUND: Cigarette smoking may increase the likelihood of developing panic disorder. Periods of nicotine withdrawal, in particular, may promote panic in individuals high in anxiety sensitivity. We examined the importance of nicotine withdrawal in the occurrence of smoking and panic. METHODS: We utilized a placebo-controlled, double-blind, randomized, crossover design. Fifty smokers underwent a breath-holding (BH) challenge after the transdermal administration of nicotine on one test day and a placebo on another test day. Physiological and psychological variables were assessed at baseline as well as directly before and after the challenges. RESULTS: Nicotine abstinence induced a decrease in heart rate and systolic blood pressure (BP) before the BH procedure (heart rate: 78.80 ± 11.43 under nicotine, 70.88 ± 10.83 under placebo; systolic BP: 124.90 ± 11.34 under nicotine, 121.18 ± 13.44 under placebo) and shorter BH duration relative to the nicotine patch condition. Nicotine abstinence did not, though, increase fear reactivity to the challenge. CONCLUSIONS: The findings for heart rate and BP are consistent with the stimulant properties of nicotine. The reduced capacity to maintain apnea under placebo might be due to carbon dioxide (CO2 ) hypersensitivity during periods of nicotine abstinence. The negative findings regarding fear reactivity might be due to BH being a relatively weak anxiogen. Future researchers are encouraged to employ CO2 -inhalation procedures to study the relationship between nicotine withdrawal and panic.

Improving awareness of best practices to reduce surgical site infection: a multistakeholder approach.

Surgical site infection (SSI) is recognized as a focus area by the Centers for Medicare and Medicaid Services, the Joint Commission, the Institute for Healthcare Improvement, and the Institute of Medicine. An estimated 47% to 84% of SSIs present after discharge from the hospital or ambulatory care facility and, as a result, go undetected by standard SSI surveillance programs. Evidence-based processes and practices that are known to reduce the incidence of SSIs tend to be underused in routine practice. This article describes a multistakeholder process used to develop an educational initiative to raise awareness of best practices to reduce SSIs. The goal was to create a patient-centric educational initiative that involved an active partnership among all stakeholders-medical professional organizations, hospitals/health systems, health insurers, employers and other purchasers, and consumers/patients-to provide the climate necessary to create and sustain a culture of safety.

Comprehensive perinatal safety initiative to reduce adverse obstetric events.

A comprehensive perinatal safety initiative (PSI) was incrementally introduced from August 2007 to July 2009 at a large tertiary medical center to reduce adverse obstetrical outcomes. The PSI introduced: (1) evidence-based protocols, (2) formalized team training with emphasis on communication, (3) standardization of electronic fetal monitoring with required documentation of competence, (4) a high-risk obstetrical emergency simulation program, and (5) dissemination of an integrated educational program among all healthcare providers. Eleven adverse outcome measures were followed prospectively via modification of the Adverse Outcome Index (MAOI). Additionally, individual components were evaluated. The logistic regression model found that within the first year, the MAOI decreased significantly to 0.8% from 2% (p<.0004) and was maintained throughout the 2-year period. Significant decreases over time for rates of return to the operating room (p<.018) and birth trauma (p<.0022) were also found. Finally, significant improvements were found in staff perceptions of safety (p<.0001), in patient perceptions of whether staff worked together (p<.028), in the management (p<.002), and documentation (p<.0001) of abnormal fetal heart rate tracings, and the documentation of obstetric hemorrhage (p<.019). This study demonstrates that a comprehensive PSI can significantly reduce adverse obstetric outcomes, thereby improving patient safety and enhancing staff and patient experiences.

Development and validation of the smoking abstinence expectancies questionnaire.

INTRODUCTION: Despite evidence that expectancies influence the use and effects of drugs, there are no questionnaires that assess abstinence expectancies among smokers. Such a questionnaire may assist prediction models of successful quitting, enable clinicians to target specific expectancies, and give researchers a broader understanding of cognitive processes that influence smoking. METHODS: We aimed to develop a questionnaire that assesses, among daily smokers, expected short-term psychological and physiological consequences to (hypothetically) abstaining from smoking. Initial scale items, completed by 326 smokers, were constructed on the basis of theory, empirical evidence, and expert review. RESULTS: The final Smoking Abstinence Expectancies Questionnaire (SAEQ) has 28 items and 4 internally consistent subscales: Negative Mood (e.g., "I would feel grouchy"), Somatic Symptoms (e.g., "My throat would feel dry"), Harmful Consequences (e.g., "I would feel like I'm dying"), and Positive Consequences (e.g., "I would feel calm"). The full scale showed good internal consistency (∝ = .86), test-retest reliability over a 2-week span (r = .82), as well as convergent and discriminant validity. CONCLUSIONS: The present study provides preliminary support for the SAEQ as a tool in smoking cessation research and treatment planning.

Nicotine withdrawal exacerbates fear reactivity to CO2-induced bodily sensations among smokers.

INTRODUCTION: Independent lines of research suggest that smoking increases the prospective risk of panic disorder. Studies that have examined the hypothesized link between nicotine withdrawal and panic have typically employed light smokers or lacked optimal control groups. Our laboratory team previously found, for example, that smokers who abstained from cigarettes for 12 hr demonstrated greater fear reactivity to a CO(2) rebreathing challenge than nonsmokers. However, the absence of a smoking-as-usual group limited our ability to draw conclusions about the potential role of nicotine withdrawal. METHODS: We exposed 27 heavy smokers who abstained from smoking for 12 hr and 27 heavy smokers who smoked as usual to a 5-min CO(2) rebreathing challenge. RESULTS: More intense prechallenge nicotine withdrawal symptoms (regardless of group status) were associated with more severe panicky symptoms and a stronger urge to escape during the challenge, even after we controlled for prechallenge anxiety and daily cigarette use. Unexpectedly, group status did not predict challenge reactivity. CONCLUSION: Smokers who regularly experience intense withdrawal symptoms, regardless of length of smoking abstinence, may be at heightened risk for experiencing panic attacks.

Vascular endothelial growth factor in diabetic and nondiabetic canine cataract patients.

OBJECTIVE: To measure vascular endothelial growth factor (VEGF) levels in aqueous humor, serum, and plasma in diabetic and nondiabetic cataractous dogs. METHODS: Canine VEGF was assayed in the plasma and serum of 32 dogs (20 diabetics; 12 nondiabetics) and aqueous humor in 57 eyes of those dogs (39 diabetic; 18 nondiabetic) undergoing phacoemulsification, using a commercial canine VEGF assay. Statistical analysis was performed using Fisher's PLSD, t-test, and regression analysis to compare values by diabetic status, duration of diabetes, age, weight, gender, left vs. right eye, and blood clarity. RESULTS: Plasma, but not serum or aqueous humor VEGF values of diabetics were significantly greater than nondiabetics (P = 0.019). Older nondiabetics (10-15 years) had higher plasma VEGF values than younger (0-5 and 5-10 years) dogs (P = 0.0002 and 0.0001, respectively). There was no significant difference in aqueous humor VEGF between left and right eyes in all patients. Serum and plasma, but not aqueous humor, VEGF values in females were significantly higher than males in both groups. CONCLUSION: Similar to human diabetic patients, VEGF aqueous humor values in all dogs are significantly higher than blood values. Aqueous humor VEGF values in human diabetics are elevated and correlate with the severity of diabetic retinopathy. However, aqueous humor values of VEGF in diabetic dogs are not greater than nondiabetics and may serve to protect the dog against development of diabetic retinopathy.

Personality, gender, and family history in the prediction of college gambling.

The present study examined the degree to which gambling behaviors and gambling-relevant cognitive distortions could be predicted by personality factors, gender, and familial history of substance use and gambling problems in a large sample of college students (N = 581). Results indicate that parental gambling problems and, especially for males, a propensity to experience negative emotions predicted time spent gambling and gambling problems. Negative emotionality, along with parental substance use problems, impulsivity, and being male predicted gambling-related cognitive distortions. The differing pattern for impulsivity with respect to behaviors and beliefs might be explained by the low accessibility of gambling venues for the student population. We compare the present findings with past studies examining gambling behaviors in adult populations.

Cigarette smoking and panic: a critical review of the literature.

OBJECTIVE: Cigarette smoking increases the risk of panic disorder with or without agoraphobia's emerging. Although the cause of this comorbidity remains controversial, the main explanations are that (1) cigarette smoking promotes panic by inducing respiratory abnormalities/lung disease or by increasing potentially fear-producing bodily sensations, (2) nicotine produces physiologic effects characteristic of panic by releasing norepinephrine, (3) panic disorder promotes cigarette smoking as self-medication, and (4) a shared vulnerability promotes both conditions. The aim of this review was to survey the literature in order to determine the validity of these explanatory models. DATA SOURCES: Studies were identified by searching English language articles published from 1960 to November 27, 2008, in MEDLINE using the key words: nicotine AND panic, tobacco AND panic, and smoking AND panic. STUDY SELECTION: Twenty-four studies were reviewed and selected according to the following criteria: panic disorder with or without agoraphobia and nicotine dependence, when used, diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, Fourth Edition, or Fourth Edition, Text Revision; no additional comorbidity or, if present, adjustment for it in the statistical analyses; use of adult or adolescent samples; comparison with a nonclinical control group or application of a crossover design. DATA EXTRACTION: Non-significant results or trends only were reported as no difference. Data on anxiety disorders or substance abuse in general were not included. DATA SYNTHESIS: Panic and cigarette smoking each appear to have the capacity to serve as a causal factor/facilitator in the development of the other. Although the temporal pattern and the pathogenetic explanations of such a co-occurrence are still being discussed, cigarette smoking tends to precede the onset of panic and to promote panic itself. CONCLUSIONS: Additional studies are strongly recommended.

Breed predisposition to congenital alacrima in dogs.

OBJECTIVE: To evaluate the clinical characteristics and breed predisposition of congenital alacrima in dogs. Animals studied Dogs with congenital keratoconjunctivitis sicca. PROCEDURES: A search of the medical records of the University of Tennessee Veterinary Teaching Hospital from 1974-2005 and the University of California-Davis Veterinary Teaching Hospital from 1986-2006 for dogs under 1 year of age with a diagnosis of keratoconjunctivitis sicca (KCS) was performed. These cases were further reviewed for dogs with a Schirmer's tear test I of

Linkages between cigarette smoking outcome expectancies and negative emotional vulnerability.

The present investigation examined whether smoking outcome expectancies, as measured by the Smoking Consequences Questionnaire (SCQ; [Brandon, T.H., & Baker, T.B., (1991). The Smoking Consequences Questionnaire: The subjective expected utility of smoking in college students. Psychological Assessment, 3, 484-491.]), were incrementally related to emotional vulnerability factors among an adult sample of 202 daily cigarette smokers (44.6% women; M(age)=23.78 years, SD=9.69 years). After controlling for cigarettes smoked/day, past 30-day marijuana use, current alcohol consumption, and coping style, negative reinforcement/negative affect reduction outcome expectancies were significantly associated with greater levels of negative affectivity, emotional dysregulation, and anxiety sensitivity. The observed effects for negative reinforcement/negative affect reduction also were independent of shared variance with other outcome expectancies. Negative personal consequences outcome expectancies were significantly and incrementally related to anxiety sensitivity, but not negative affectivity or emotional dysregulation. Findings are discussed in terms of the role of negative reinforcement/negative affect reduction smoking outcome expectancies and clinically-relevant negative emotional vulnerability for better understanding cigarette smoking-negative mood problems.

Fear reactivity to bodily sensations among heavy smokers and nonsmokers.

Individuals who smoke are more likely to experience panic attacks and develop panic disorder than those in the general population. One possible explanation is that smokers may experience a heightened fear response to somatic disturbances. To date, few laboratory studies have tested this hypothesis directly. The present study examined 24 adult heavy smokers (10 females) in 12-hr nicotine withdrawal and 24 adult nonsmokers (12 females) on subjective and physiological reactivity to a 4-min carbon dioxide rebreathing challenge. Results indicate that, despite an attenuated acceleration in respiration during the challenge, smokers experienced a significantly greater increase in self-reported panic symptoms than nonsmokers. In addition, smokers reported significantly greater trait levels of suffocation fear prior to the challenge. Findings are discussed with respect to the role of smoking in panic vulnerability.

Biological challenge procedures used to study co-occurring nicotine dependence and panic disorder.

A wide array of biological challenge procedures - including carbon dioxide inhalation, hyperventilation, and breath holding - have been used to model panic in laboratory settings. Originally used to study developmental processes in panic disorder (PD), these procedures, along with nicotine patch administration and self-administered smoking, have recently been applied to help understand the etiology of co-occurring nicotine dependence and PD. The goals of the present paper are to review studies that have employed biological challenges to study the comorbid condition, identify the advantages and limitations of the various procedures, describe desirable outcome measures for use in biological challenges, and present recommendations for future challenge studies in this field. We argue that biological challenges, though in need of standardization, are useful for studying the development, maintenance, prevention, and treatment of comorbid nicotine dependence and PD.