Exploring the psychology of suicidal ideation: A theory driven network analysis.

Two leading theories within the field of suicide prevention are the interpersonal psychological theory of suicidal behaviour (IPT) and the integrated motivational-volitional (IMV) model. The IPT posits that suicidal thoughts emerge from high levels of perceived burdensomeness and thwarted belongingness. The IMV model is a multivariate framework that conceptualizes defeat and entrapment as key drivers of suicide ideation. We applied network analysis to cross-sectional data collected as part of the Scottish Wellbeing Study, in which a nationally representative sample of 3508 young adults (18-34 years) completed a battery of psychological measures. Network analysis can help us to understand how the different theoretical components interact and how they relate to suicide ideation. Within a network that included only the core factors from both models, internal entrapment and perceived burdensomeness were most strongly related to suicide ideation. The core constructs defeat, external entrapment and thwarted belonginess were mainly related to other factors than suicide ideation. Within the network of all available psychological factors, 12 of the 20 factors were uniquely related to suicide ideation, with perceived burdensomeness, internal entrapment, depressive symptoms and history of suicide ideation explaining the most variance. None of the factors was isolated, and we identified four larger clusters: mental wellbeing, interpersonal needs, personality, and suicide-related factors. Overall, the results suggest that relationships between suicide ideation and psychological risk factors are complex, with some factors contributing direct risk, and others having indirect impact.

Conscientiousness and medication adherence: a meta-analysis.

BACKGROUND: Approximately a quarter to a half of all people fail to take their medication regimen as prescribed (i.e. non-adherence). Conscientiousness, from the five-factor model of personality, has been positively linked to adherence to medications in several recent studies. PURPOSE: This study aimed to systematically estimate the strength and variability of this association across multiple published articles and to identify moderators of this relationship. METHOD: A literature search identified 16 studies (N = 3,476) that met the study eligibility criteria. Estimates of effect sizes (r) obtained in these studies were meta-analysed. RESULTS: Overall, a higher level of conscientiousness was associated with better medication adherence (r = 0.15; 95 % CI, 0.09, 0.21). Associations were significantly stronger in younger samples (r = 0.26, 95 % CI, 0.17, 0.34; k = 7). CONCLUSION: The small association between conscientiousness and medication adherence may have clinical significance in contexts where small differences in adherence result in clinically important effects.

Late effects of a brief psychological intervention in patients with intermittent claudication in a randomized clinical trial.

BACKGROUND: The authors previously reported the early results of a trial of a brief psychological intervention to increase physical activity in patients with intermittent claudication. After 4 months, participants in the intervention group walked a mean of 1576 more steps per day than control group participants. The present study followed the original participants to determine whether this behaviour change was maintained over 2 years. METHODS: This was a randomized single-centre parallel-group trial. Fifty-eight patients newly diagnosed with intermittent claudication were assigned randomly to one of two groups. The control group (30 patients) received usual care: lifestyle advice and consultation with a vascular surgeon to agree a treatment plan. The treatment group (28) received usual care plus a brief psychological intervention designed to modify illness and walking beliefs, and develop a personalized walking action plan. The primary outcome was daily steps measured by pedometer. Secondary outcomes included revascularization rate, quality of life and perceived pain-free walking distance. Follow-up was conducted at 1 and 2 years. Between-group differences were analysed by analysis of co-variance. RESULTS: Participants in the brief psychological intervention group walked significantly more than those in the control group. The mean difference at 1 year was 1374 (95 per cent confidence interval 528 to 2220) steps per day and the difference at 2 years was 1630 (495 to 2765) steps per day. CONCLUSION: Modifying illness and walking beliefs, and assisting patients to develop a personalized walking action plan led to increases in walking behaviour in patients with claudication that were maintained for 2 years. REGISTRATION NUMBER: ISRCTN28051878 (http://www.controlled-trials.com).

Intimate partner abuse and suicidality: a systematic review.

Research has demonstrated an association between intimate partner abuse and suicidality, presenting a serious mental health issue. However, studies have differed widely in the samples and methods employed, and in the depth of the investigation. Given the level of heterogeneity in the literature, this systematic review examines, for the first time, the nature of the relationship between intimate partner abuse and suicidality. The three main psychological and medical databases (PsychInfo 1887-March 2011; Medline, 1966-March 2011; Web of Knowledge 1981-March 2011) were searched. Thirty-seven papers on the topic of intimate partner abuse and suicidality were found. With only one exception, all of the studies found a strong and consistent association between intimate partner abuse and suicidality. Significantly, this relationship held irrespective of study design, sample and measurement of abuse and suicidality, thus demonstrating a consistently strong relationship between intimate partner abuse and suicidality. This review highlights that intimate partner abuse is a significant risk factor for suicidal thoughts and behaviours, which has important clinical implications.

Randomized clinical trial of a brief psychological intervention to increase walking in patients with intermittent claudication.

BACKGROUND: Increased walking is often recommended for patients with intermittent claudication (IC). Current methods to increase walking in these patients increase capability but not daily behaviour. This trial assessed whether a brief psychological intervention could increase daily walking at 4 months. METHODS: This randomized, single-centre, parallel-group trial was conducted between April 2008 and July 2010. Patients newly diagnosed with IC were randomly assigned into two groups. All clinical staff involved in patient management were blinded to allocation. The control group received usual care plus researcher contact, and the treatment group received usual care and a brief psychological intervention to modify illness and walking beliefs and to develop a personalized walking action plan. The psychological intervention was delivered in two 1-h sessions in participants' homes. The primary outcome was daily steps measured by pedometer 4 months later. Analyses were by intention to treat. RESULTS: Of 109 patients screened, 72 were eligible for inclusion; 58 patients consented to participate and were randomly allocated to usual care (30) or brief psychological intervention (28). All 58 participants were included in the analysis of the primary outcome. Compared with controls at 4-month follow-up, participants who received the psychological intervention walked a mean of 1575·63 (95 per cent confidence interval 731·97 to 2419·29) more steps per day. There were no adverse events. CONCLUSION: A brief psychological intervention significantly increased daily walking in patients with IC at 4 months. This study provided support for a potentially new direction in the treatment of IC. REGISTRATION NUMBER: ISRCTN28051878 (http://www.controlled-trials.com).

Examining the effect of spinal cord injury on emotional awareness, expressivity and memory for emotional material.

The prevailing view on the effects of spinal cord injury (SCI) on emotion is that it dampens emotional experience due to a loss of peripheral bodily feedback, with the higher the lesion on the spinal cord the greater the reduction in the intensity of emotional experience. This view persists despite many studies showing an absence of such an emotional impairment in people with SCI. This study specifically aimed to investigate whether total cervical-6 spinal cord transection (i) reduces emotional expressivity and emotional awareness (ii) impairs memory for emotional material. The study contained three groups: 24 patients with SCI, 20 orthopaedic injury control (OIC) patients and 20 young adult controls. A mixed factor design was employed to examine between group and within subject differences. Participants completed the Levels of Emotional Awareness Scale (LEAS), the Berkeley Expressivity Questionnaire (BEQ), and viewed an emotionally arousing slide presentation. Thirty minutes post viewing, participants completed memory tests for the presentation. SCI patients reported greater present levels of emotional expressivity compared with perceived levels prior to their injuries. SCI and OIC groups did not differ on any of the emotional awareness variables. There was also no evidence that SCI leads to impairment in memory for emotional events. This study's findings contradict the mainstream view in the cognitive neuroscience of emotion that SCI dampens emotional experience.

Extent of prevalence and size of flat neoplasms in a heterogeneous population undergoing routine colorectal cancer screening.

BACKGROUND: The importance of identifying flat colorectal neoplasms is increasingly appreciated, although the extent of prevalence of these lesions in a general population is not known. OBJECTIVE: To determine the extent of prevalence of flat neoplasms in a diverse population undergoing routine endoscopic screening for colorectal cancer. DESIGN: Patients referred to the Colorectal Cancer Screening Clinic over a 12-month period (n = 642). RESULTS: The patient population was 56% African American and 21% Caucasian; with a mean age of 59 + or - 9 years. Flat neoplasms were detected in 5.5% of all patients, similar to that reported elsewhere, with extent of prevalence being similar regardless of gender or race. Average size of flat neoplasms was of 2.8 + or - 2.3 mm (range 1-20 mm). However, there was no evidence of advanced pathology in any of the flat neoplasms identified. CONCLUSIONS: Flat neoplasms are common but may not be associated with advanced pathology in a population undergoing routine screening.

Neuropsychological functioning, illness perception, mood and quality of life in chronic fatigue syndrome, autoimmune thyroid disease and healthy participants.

BACKGROUND: This study attempted to longitudinally investigate neuropsychological function, illness representations, self-esteem, mood and quality of life (QoL) in individuals with chronic fatigue syndrome (CFS) and compared them with both healthy participants and a clinical comparison group of individuals with autoimmune thyroid disease (AITD). METHOD: Neuropsychological evaluation was administered at two time points, five weeks apart. Twenty-one individuals with CFS, 20 individuals with AITD and 21 healthy participants were matched for age, pre-morbid intelligence, education level and socio-economic status (SES). All groups also completed measures of illness perceptions, mood, self-esteem and QoL at both time points. RESULTS: The CFS group showed significantly greater impairment on measures of immediate and delayed memory, attention and visuo-constructional ability, and reported significantly higher levels of anxiety and depression. After controlling for the effects of mood, the CFS group still demonstrated significant impairment in attention. The CFS group also reported significantly lower self-reported QoL than the AITD and healthy participants. In terms of illness perceptions, the AITD group believed that their condition would last longer, that they had more treatment control over their condition, and reported less concern than the CFS group. CONCLUSIONS: These results suggest that the primary cognitive impairment in CFS is attention and that this is not secondary to affective status. The lower treatment control perceptions and greater illness concerns that CFS patients report may be causally related to their affective status.

Dual task performance in early Alzheimer's disease, amnestic mild cognitive impairment and depression.

BACKGROUND: The dual task paradigm (Baddeley et al. 1986; Della Sala et al. 1995) has been proposed as a sensitive measure of Alzheimer's dementia, early in the disease process. METHOD: We investigated this claim by administering the modified dual task paradigm (utilising a pencil-and-paper version of a tracking task) to 33 patients with amnestic mild cognitive impairment (aMCI) and 10 with very early Alzheimer's disease, as well as 21 healthy elderly subjects and 17 controls with depressive symptoms. All groups were closely matched for age and pre-morbid intellectual ability. RESULTS: There were no group differences in dual task performance, despite poor performance in episodic memory tests of the aMCI and early Alzheimer's disease groups. In contrast, the Alzheimer patients were specifically impaired in the trail-making test B, another commonly used test of divided attention. CONCLUSIONS: The dual task paradigm lacks sensitivity for use in the early differential diagnosis of Alzheimer's disease.

Neuropsychological aspects of liver disease and its treatment.

Liver disease can lead to serious impairment in cognitive functioning, through the development of a condition known as hepatic encephalopathy (HE). While gross impairment is clinically obvious, milder variants of the condition may escape detection at bedside examination and yet may have a significant impact on day-to-day activities. In this brief review article, the neuropsychology of liver disease is examined, focusing on nature, aetiology and significance. The possible contributory role of endogenous benzodiazepines in HE is described, as is the evidence regarding the effect of benzodiazepine antagonism on cognitive functioning in HE. The functional localisation of HE is briefly reviewed, as is the use of neuropsychological measures to evaluate treatment efficacy, e.g. following shunt procedures or liver transplantation. Finally, living donor liver transplantation is described, and the case is made for rigorous longitudinal neuropsychological evaluation of potential donors and recipients.

Colon preparation for magnification endoscopy: a rapid novel approach.

BACKGROUND AND STUDY AIMS: Minute lesions in the colon are of increasing clinical interest. Conventional endoscopic techniques are inadequate for visualizing these lesions, and magnification chromoendoscopy is required to identify them. This study compared the effectiveness of a simpler colon preparation method with the standard technique. Patients and Methods : Seven patients received dilute methylene blue (0.05 %) by enema prior to the endoscopic evaluation. The extent, quality, and ease of dye delivery were compared with the standard methods. RESULTS: Dye delivery by enema extended to the splenic flexure and was uniformly applied, and advancement of the endoscope was easier. This alternative method was better tolerated by patients (visual analogue scale 1.9 +/- 0.3 vs. 3.8 +/- 0.8; P = 0.004). CONCLUSION: This rapid and reliable method of visualizing the entire left colon with dye magnification allows magnification chromoendoscopy to be carried out in a convenient manner that is also less painful for the patient.

Decision making in humans: the effect of manipulating the central noradrenergic system.

OBJECTIVES: Damasio has proposed an influential model of human decision making-the Somatic Marker Hypothesis (SMH), where he argues that somatic feedback to the brain influences decision making in humans. It is proposed that when choosing between options that differ in relative risk, a somatic marker (for example, a "gut feeling") feeds back to the brain and influences cognitive appraisal. This study tested the hypothesis that the noradrenergic system may play a part in this afferent feedback process. METHODS: Thirty healthy young adults were randomly allocated to receive placebo, 4 mg, or 8 mg reboxetine (a new selective noradrenergic reuptake inhibitor that acts to increase central noradrenergic activity). It is hypothesised that enhancement of central noradrenergic activity may amplify the effect of afferent feedback, and lead to altered decision making. All subjects completed the Iowa Gambling Task (IGT), a computerised card playing game where the player is instructed to try and win as much money as possible over 100 selections from one of four decks. RESULTS: There were no significant differences between the three groups in gambling task performance. CONCLUSION: This result suggests that central noradrenergic activity may not be critically involved in the afferent feedback mechanism that is central to the somatic marker hypothesis.

Dissociation of affective modulation of recollective and perceptual experience following amygdala damage.

It has been suggested that similar neural mechanisms may underlie the affective modulation of both recollective and perceptual experience. A case is reported of a patient who has bilateral amygdala damage and marked impairment in the perception of emotion, particularly fear. The patient DR and 10 healthy control subjects (matched for school leaving age, intelligence quotient, and non-emotional memory performance) were shown a series of slides accompanied by an emotionally arousing narrative. One week later DR and the controls were given a surprise memory test for this material. In addition, they completed a verbal memory test using emotionally arousing stimuli. Both DR and the healthy control subjects showed a normative pattern of enhanced memory for emotional material. On the basis of these results and the previously demonstrated impairment of perception of emotion in this patient, it is concluded that different neural mechanisms may underlie affective modulation of recollective and perceptual experience.

Assessing the emotional impact of cadaver dissection on medical students.

AIM: The study's first aim was to assess the emotional impact of cadaver dissection on first year medical students using the newly developed Appraisal of Life Events Scale (ALE). Its secondary aim was to evaluate the validity of the ALE by comparing it with the Impact of Events Scale (IOE). SETTING: Division of Biomedical Sciences, School of Biology, University of St. Andrews. SUBJECTS AND METHOD: Appraisal of Life Events and Impact of Events data were obtained from 114 UK medical students 4 weeks after their first cadaver dissecting class. Main outcome measures referred to the ALE and IOE scales. RESULTS: The students rated the experience as largely positive, registering significantly higher scores on the ALE challenge factor than on ALE threat or ALE loss. Significant correlations between ALE threat and loss scores and IOE intrusions and avoidance scores were noted. CONCLUSION: The results indicate that medical students do not report their first exposure to cadaver dissection as an aversive experience. Instead, as the ALE results confirm, they found it to be a positive and challenging life event. The ALE appears to be a useful instrument in assessing positive and negative emotional reactions to significant life events.

Psychological factors associated with delay in attending hospital following a myocardial infarction.

OBJECTIVE: There is wide variability in latency to attend hospital following a myocardial infarction (MI). The present study assessed possible psychological factors that may be implicated in delayed presentation. METHOD: Seventy-two patients who had experienced a confirmed MI were interviewed in hospital, 3-5 days post-MI. They completed a series of psychological measures of cardiac denial, cardiac threat, alexithymia, health locus of control, neuroticism and mood. RESULTS: Those patients who believed that they were having a heart attack sought help quicker than those who did not, and those who waited over 4 hours prior to seeking medical help had significantly lower scores on neuroticism, and higher scores on denial and health locus of control (chance). Confirmatory multiple regression analysis using an alternative estimate of delay in seeking help confirmed that health locus of control (chance) was the best predictor of delayed attendance. CONCLUSION: The present study confirms that the belief that one is having a MI is associated with prompt attendance, and additionally that the belief that health outcomes are largely due to chance factors is associated with delayed presentation following a MI. This delay could prove fatal. Modification of such beliefs may reduce response times and, thus, increase survival rates.

The case for gastrin-releasing peptide acting as a morphogen when it and its receptor are aberrantly expressed in cancer.

Gastrin-releasing peptide (GRP) and its receptor (GRP-R) are frequently expressed by cancers of the gastrointestinal tract, breast, lung, and prostate. Most studies have found that GRP and its amphibian homologue bombesin act to increase tumor cell proliferation, leading to the hypothesis that this peptide hormone is a mitogen important for the growth of various cancers. Yet GRP/GRP-R co-expression in cancer promotes the development of a well-differentiated phenotype; while multiple studies suggest that the presence of these 2 proteins confer a survival advantage. Along with recent reports showing that GRP and its receptor critically regulate aspects of colon and lung organogenesis, we argue that these proteins do not function primarily as mitogens when aberrantly expressed in cancer. Rather, we postulate that GRP/GRP-R are onco-fetal antigens that function as morphogens, with their effect on tumor cell proliferation being a component property of their ability to regulate differentiation. Thus aberrant GRP/GRP-R expression in cancer recapitulates, albeit in a dysfunctional manner, their normal role in development.

Decision making in patients with spinal cord damage: afferent feedback and the somatic marker hypothesis.

Damasio has proposed an influential model of human decision making - the somatic marker hypothesis (Damasio AR. Descates' Error. London: Papermac/Macmillan, 1994), where he argues that somatic feedback to the brain influences decision making in man. It is proposed that when choosing between options that differ in relative risk, a somatic marker (e.g. a 'gut feeling') feeds back to the brain and influences cognitive appraisal. In the present study patients who had suffered a complete tetraplegia at the level of the sixth cervical vertebra were compared with matched healthy control subjects. As the spinal injury group have reduced somatic/peripheral feedback via the spinal cord, it was predicted, based on the somatic marker hypothesis, that they may demonstrate riskier behaviour than controls. All subjects completed the Iowa Gambling Task, a computerised card playing game where the player is instructed to try and win as much money as possible over 100 selections from one of four decks. The rules are not disclosed in advance, and the player gradually 'learns' that two of the decks are 'high risk' and lead to significant financial losses. Healthy individuals have previously been shown to learn to avoid the risky decks, whereas patients with medial frontal lobe damage (Bechara A, Damasio AR, Damasio H, Anderson SW. Insensitivity to future consequences following damage to human prefrontal cortex. Cognition 1994;50:7-15) and those with peripheral neuropathy (Bechara A, Tranel D, Wilson J, Heberlein AS, Ross M, Damasio AR, 1998. Impaired decision-making in peripheral neuropathy. Society for Neuroscience Abstracts 24:1176) select an excessive number from the risky decks, and consequently lose money. In the present study there were no significant differences between the spinal sectioned and healthy control groups in either card selection strategy or net financial outcome. This result suggests that in terms of the somatic marker hypothesis, feedback to the brain from the periphery via the cranial vagus and other nerves and the hormonal route may be equally or more influential than afferent feedback transmitted via the spinal cord.

Chronicity of memory impairment in long-term out-of-hospital cardiac arrest survivors.

As a result of out-of-hospital defibrillation initiatives, many cities have an increasing population of out-of-hospital cardiac arrest survivors. We previously identified that one third of these patients suffer memory problems in the months after resuscitation. The pattern of memory impairment (impaired recall memory and intact recognition memory) is suggestive of hippocampal damage. In this study we followed up ten subjects who had previously been found to have memory impairment after their cardiac arrest. To assess the chronicity of this memory impairment, we re-tested memory function approximately 3 years after the index events. These subjects were compared with age and sex matched control subjects with previous myocardial infarction and no cardiac arrest. Memory was assessed using the Rivermead Behavioural Memory test (RBMT). To further assess recall and recognition memory we used the Doors and People test (DPT), which is specifically designed to identify deficits in these functions. RBMT scores declined significantly in both groups compared with the original assessment 8 months after cardiac arrest, possibly an effect of ageing-control group: mean (S.D.) 22.2 (1. 4)-18.4 (2.9); cardiac arrest group: 16.1 (2.7)-14.6 (4.4). The inter-group difference in RBMT score remained significant (P=0.001). DPT scores were poor in the cardiac arrest group (mean (S.D.) total 5.8 (2.8)), compared with the control group (10.8 (3.4)) who scored normally. Both recall and recognition memory were poor in the cardiac arrest group. We conclude that the memory deficits that we previously observed in cardiac arrest victims are persistent. Both recall and recognition memory are affected, implying that non-selective brain injury may be the mechanism.

A comparison of the WHOQOL-100 and the WHOQOL-BREF in detecting change in quality of life following liver transplantation.

The World Health Organization has recently produced a generic quality of life measure--the WHOQOL-100, together with an abbreviated version, the WHOQOL-BREF. Preliminary data suggest that the WHOQOL BREF provides a valid and reliable alternative to the lengthier WHOQOL-100. In the present study, the sensitivity to change of both versions was tested pre- and 3 months post liver transplantation in fifty patients and also in twenty-one non-transplanted liver disease controls. Quality of Life domains on both measures were highly correlated, and were sensitive to change following transplant and remained stable on repeat assessment in non-transplanted control patients. However, the sensitivity to change was significantly reduced for the Social domain in the WHOQOL BREF. It is concluded that the WHO-QOL-BREF is a useful alternative to the WHOQOL-100 in evaluating quality of life improvement following major therapeutic interventions for Physical, Psychological and Environmental domains of life quality. However, researchers interested in measuring the Social aspects of life quality may be best advised to use the lengthier WHOQOL-100.