Obsessive-Compulsive Disorder: A Medical School Curriculum and Textbook Review.

OBJECTIVES: We conducted a curriculum review of Canadian undergraduate medical programs to identify why aggressive obsessions (among those with obsessive-compulsive disorder [OCD]) are so often misidentified by primary care physicians and professional students. METHODS: This study involved standardized interviews with representatives from Canadian medical schools regarding the content, time, and teaching styles used to deliver curricula related to OCD. Further, we utilized a set of standardized criteria to assess the OCD content of recommended textbooks from these schools. RESULTS: Canadian medical curricula failed to provide a comprehensive picture of OCD. One-third of medical programs did not provide an example of aggressive obsessions to students, with textbook case examples centered heavily (70%) on contamination or symmetry. Only 25% of programs (and 60% of textbooks) discussed the composition of the Unacceptable Thought Domain to include aggressive, sexual, and religious obsessions. Finally, over half of medical programs failed to indicate that aggressive obsessions are ego-dystonic and do not lead people to harm themselves or others. CONCLUSION: A series of recommendations are provided for medical schools intended to improve the comprehensiveness of OCD-related training.

The prevalence of cannabis use disorder in attention-deficit hyperactivity disorder: A clinical epidemiological meta-analysis.

Studies have shown that individuals with attention-deficit hyperactivity disorder (ADHD) pose an increased risk for developing substance use disorders. Increased cannabis product accessibility and recent legislative changes have led to increased cannabis consumption, thereby increasing the risk of cannabis use disorder (CUD). The present meta-analysis explored the lifetime and current prevalence of CUD in ADHD. A systematic review was conducted using the following databases: PubMed, PsycINFO and Web of Science. A total of 14 articles were included and used to estimate the aggregate lifetime and current prevalence of CUD in ADHD alongside risk ratios comparing increased risk of CUD in ADHD versus control samples. Mixed and random-effects models indicated that lifetime and current prevalence rates of CUD in ADHD populations were 26.9% and 19.2%, respectively (although prediction intervals ranged from 12.4% to 48.8% and 5.5%-39.1%, respectively). Analysis of the risk ratios indicated that those with ADHD were at 2.85- and 2.91-times greater risk of a lifetime or current diagnosis of CUD, respectively, than those in the general population. Our findings support the need for additional research on the prevalence of CUD in those with ADHD, as well as the inclusion of CUD screening in the treatment of ADHD.

Perceived Executive Functioning Deficits After Diagnosis in Women with Non-Metastatic Breast Cancer Prior to Adjuvant Therapies.

BACKGROUND: Perceived deficits in executive functioning are among the many difficulties that women diagnosed with breast cancer experience. This study assessed the presence of perceived deficits in executive functioning among women with breast cancer prior to systemic treatment and radiation and associations between perceived deficits in executive function and comorbid fatigue, sleep, and mood disturbance. METHOD: Participants were recruited following their breast cancer diagnosis and assessed using the Behavior Rating Inventory of Executive Function for Adults (BRIEF-A), subjective and objective measures of sleep duration and efficiency, and self-report measures of insomnia severity, sleep quality, fatigue, and mood disturbance. Hierarchical regression was used to examine associations between symptoms, adjusting for age and education. RESULTS: The final sample included 92 women with a mean age of 60.7 years and 13.5 years of education. Thirteen percent of participants reported global executive dysfunction. After partitioning out variability from other independent variables, fatigue (p = < .001), perceived sleep quality (p = .030), and symptoms of insomnia (p = .008) accounted for 13.3%, 5.7%, and 8.5% of unique variance in perceived executive functioning, respectively. Emotional fatigue was most strongly associated with perceived deficits in executive functioning. Neither subjective or objective sleep duration or efficiency was associated with perceived deficits in executive functioning. CONCLUSION: Fatigue, particularly emotional fatigue, insomnia, and poor sleep quality had the strongest associations with perceived deficits in executive functioning. Sleep interventions and fatigue management strategies may prove useful for women who seek to improve their perceived executive functioning.

Item-method directed forgetting is (usually) impaired in clinical populations: A meta-analysis.

The item-method directed forgetting paradigm is a common laboratory task used to measure memory control. While impaired memory control may contribute to the development and/or maintenance of a variety of psychological disorders, comparisons between clinical and nonclinical groups using this paradigm have been inconsistent-even within the same disorder. A systematic search for related articles utilizing clinical populations was conducted revealing 823 articles of which 36 met inclusion criteria. Raw mean differences were calculated and aggregated using Bayesian multilevel random-effects models. These models revealed a significant difference in the magnitude of directed forgetting between clinical and control populations, such that clinical populations (collapsing across all disorders or combining only the critical anxiety and depression clusters) exhibited a reduced directed forgetting effect. This difference tended to be larger in clinical (as opposed to clinical-analog) populations and in older samples. These results support the notion that item-method directed forgetting provides a suitable measure of memory control sensitive to real-world control deficits and further implies that memory control deficits may contribute to mental illness (although causality remains to be determined). (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Evaluating the efficacy of oxytocin for pain management: An updated systematic review and meta-analysis of randomized clinical trials and observational studies.

Background: There is a need for novel analgesics with favorable risk to benefit profiles. Oxytocin has recently gained attention for its potential analgesic properties. Aim: The aim of this study was to perform an updated systematic review and meta-analysis evaluating the effect of oxytocin for pain management. Method: Ovid MEDLINE, Embase, PsycINFO, CINAHL, and Clinicaltrials.gov were searched for articles reporting on associations between oxytocin and chronic pain management from January 2012 to February 2022. Studies published before 2012 that were identified in our previous systematic review were also eligible. Risk of bias of included studies was assessed. Synthesis of results was performed using meta-analysis and narrative synthesis. Results: Searches returned 2087 unique citations. In total, 14 articles were included that reported on 1504 people living with pain. Results from meta-analysis and narrative review were mixed. Meta-analysis of three studies indicated that exogenous oxytocin administration did not result in a significant reduction in pain intensity relative to placebo (N = 3; n = 95; g = 0.31; 95% confidence interval [CI] -0.10, 0.73). Narrative review provided encouraging evidence that exogenous oxytocin administration reduced pain sensitivity among individuals with back pain, abdominal pain, and migraines. Results suggested that individual difference factors (e.g., sex and chronic pain condition) may influence oxytocin-induced nociception, but the heterogeneity and limited number of studies identified precluded further investigation. Discussion: There is equipoise for the benefit of oxytocin for pain management. Future studies are imperative and should undertake more precise exploration of potential confounds and mechanisms of analgesic action to clarify inconsistency in the literature.

Contexte: Il existe un besoin de nouveaux analgésiques présentant un profil de risque/bénéfice favorable. L'ocytocine a récemment attiré l'attention pour ses propriétés analgésiques potentielles.Objectif: L'objectif de cette étude était d'effectuer une mise à jour d'une revue systématique et une méta-analyse pour évaluer l'effet de l'ocytocine pour la gestion de la douleur.Méthode: Des recherches ont été effectuées dans Ovid MEDLINE, Embase, PsycINFO, CINAHL et Clinicaltrials.gov pour y repérer des articles sur les associations entre l'ocytocine et la prise en charge de la douleur chronique de janvier 2012 à février 2022. Les études publiées avant 2012 qui ont été recensées dans notre revue systématique précédente était également admissibles. Le risque de biais des études incluses a été évalué. Une synthèse des résultats a été réalisée à l'aide d'une méta-analyse et d'une synthèse narrative.Résultats: Les recherches ont permis de recenser 2 087 citations uniques. Au total, 14 articles portant sur 1 504 personnes vivant avec la douleur ont été incluses. Les résultats de la méta-analyse et de l'examen narratif ont été mitigés. Une méta-analyse de trois études a révélé que l'administration d'ocytocine exogène n'avait pas entraîné de réduction significative de l'intensité de la douleur comparativement au placebo (N = 3; n = 95; g = 0,31; Intervalle de confiance à 95 % [IC] −0,10 ; 0,73). L'examen narratif a fourni des preuves encourageantes que l'administration d'ocytocine exogène avait réduit la sensibilité à la douleur chez les personnes souffrant de maux de dos, de douleurs abdominales et de migraines. Les résultats indiquent que les facteurs de différence individuels (par exemple, le sexe et la douleur chronique) peuvent influencer la nociception induite par l'ocytocine, mais le nombre limité d'études recensées et leur hétérogénéité a empêché d'approfondir l'enquête.Discussion: Il existe un équilibre au profit de l'ocytocine pour la prise en charge de la douleur. Il est primordial que d'autres études soient menées afin d'explorer de manière plus précise les facteurs de confusion et les mécanismes de l'action analgésique potentiels et ainsi clarifier l'incohérence dans la littérature.

Suppression-induced forgetting: a pre-registered replication of the think/no-think paradigm.

Post-traumatic stress disorder is characterised by recurring memories of a traumatic experience despite deliberate attempts to forget (i.e., suppression). The Think/No-Think (TNT) task has been used widely in the laboratory to study suppression-induced forgetting. During the task, participants learn a series of cue-target word pairs. Subsequently, they are presented with a subset of the cue words and are instructed to think (respond items) or not think about the corresponding target (suppression items). Baseline items are not shown during this phase. Successful suppression-induced forgetting is indicated by the reduced recall of suppression compared to baseline items in recall tests using either the same or different cues than originally studied (i.e., same- and independent-probe tests, respectively). The current replication was a pre-registered collaborative effort to evaluate an online experimenter-present version of the paradigm in 150 English-speaking healthy individuals (89 females; MAge = 31.14, SDAge = 7.73). Overall, we did not replicate the suppression-induced forgetting effect (same-probe: BF01 = 7.84; d = 0.03 [95% CI: -0.13; 0.20]; independent-probe: BF01 = 5.71; d = 0.06 [95% CI: -0.12; 0.24]). These null results should be considered in light of our online implementation of the paradigm. Nevertheless, our findings call into question the robustness of suppression-induced forgetting.

On the role of inhibition in suppression-induced forgetting.

Suppressing retrieval of unwanted memories can cause forgetting, an outcome often attributed to the recruitment of inhibitory control. This suppression-induced forgetting (SIF) generalizes to different cues used to test the suppressed content (cue-independence), a property taken as consistent with inhibition. But does cue-independent forgetting necessarily imply that a memory has been inhibited? Tomlinson et al. (Proc Natl Acad Sci 106:15588-15593, 2009) reported a surprising finding that pressing a button also led to cue-independent forgetting, which was taken as support for an alternative interference account. Here we investigated the role of inhibition in forgetting due to retrieval suppression and pressing buttons. We modified Tomlinson et al.'s procedure to examine an unusual feature they introduced that may have caused memory inhibition effects in their experiment: the omission of explicit task-cues. When tasks were uncued, we replicated the button-press forgetting effect; but when cued, pressing buttons caused no forgetting. Moreover, button-press forgetting partially reflects output-interference effects at test and not a lasting effect of interference. In contrast, SIF occurred regardless of these procedural changes. Collectively, these findings indicate that simply pressing a button does not induce forgetting, on its own, without confounding factors that introduce inhibition into the task and that inhibition likely underlies SIF.

Production improves recognition and reduces intrusions in between-subject designs: An updated meta-analysis.

The production effect refers to the finding that words read aloud are better remembered than those read silently. This pattern has most often been explained as arising from the incorporation of sensorimotor elements into the item representation at study, which could then be used to guide performance at later test. This theoretical framework views aloud items as being distinctive in relation to silent items, and thus the effect was thought to emerge only when production was manipulated within-subjects. This claim was later challenged, and a reliable (albeit smaller) between-subject production effect has since been shown in recognition memory. Across a series of meta-analyses, we extend this earlier work, replicating the between-subject production effect for recognition, and demonstrating no such effect for overall target recall. However, supporting recent theoretical claims, we further observed an interaction between the production effect and serial position within recall, such that a production effect was observed for late time points but not early time points (a similar, albeit smaller and noncredible trend was observed for recognition). Finally, we provide evidence that production reduces off-list intrusions. In summary, production has a reliable impact on recognition memory when manipulated between-subjects, but a more complex relationship with recall performance. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Characterizing production: the production effect is eliminated for unusual voices unless they are frequent at study.

The production effect refers to the finding that items read aloud are better remembered than items read silently. This is often explained with reference to distinctiveness, arguing that aloud items become associated with distinctive sensorimotor features that facilitate retrieval at test. Based on this framework, more distinctive forms of production should result in larger production effects. The present study tested this theory by having participants study items silently or aloud in either their own voice or as a popular character. Participants were then tested for those items using recognition memory. Relative to silent items, aloud items read in the participants' own voice demonstrated a typical production effect; however, contrary to any predictions, no production effect was observed for the character voices. We next manipulated how frequently the character voice was used relative to the participants' own voice. This revealed a production effect for character voices only when those voices were more common than the participant's own voice. This pattern could not be attributed to cognitive demands or performance anxiety but was predicted by a novel computational account based on the Retrieving Effectively from Memory (REM) model. Our results show that the relation between distinctiveness and memory is not necessarily linear.

Production can enhance semantic encoding: Evidence from forced-choice recognition with homophone versus synonym lures.

The production effect-better memory for words read aloud rather than silently-has been attributed to responses at test being guided by memory for the act of production. In Experiment 1, we evaluated this distinctiveness account by comparing production effects in forced-choice recognition when lures were either homophones of the targets (toad or towed?) or unrelated words (toad or seam?). If the production effect at test was driven solely by memory for the productive act (e.g., articulation, auditory processing), then the effect should be reduced with homophone lures. Contrary to that prediction, the production effect did not differ credibly between homophone-lure and unrelated-lure groups. Experiment 1 led us to hypothesize that production may also boost semantic encoding, and that participants use memory of semantic encoding to guide their forced-choice responses. Consistent with these hypotheses, using synonym lures to interfere with semantic-based decisions (poison or venom?) reduced the production effect relative to using unrelated lures (poison or ethics?) in Experiment 2. Our findings suggest that enhanced conceptual encoding may be another useful product of production.

Postpartum Thoughts of Infant-Related Harm and Obsessive-Compulsive Disorder: Relation to Maternal Physical Aggression Toward the Infant.

Objective: Unwanted intrusive thoughts (UITs) of intentional infant-related harm are ubiquitous among new mothers and frequently raise concerns about infant safety. The purpose of this research was to assess the relation of new mothers' UITs of intentional, infant-related harm and obsessive-compulsive disorder (OCD) with maternal aggression toward the infant and to document the prevalence of maternal aggression toward the infant.Methods: From a prospective, province-wide, unselected sample of 763 English-speaking postpartum women, a total of 388 participants provided data for this portion of the research. Participants completed 2 questionnaires and interviews postpartum to assess UITs of infant-related harm, OCD (based on DSM-5 criteria), and maternal aggression toward the infant. Data for this research were collected from February 9, 2014, to February 14, 2017.Results: Overall, few participants (2.9%; 95% CI, 1.5% to 4.7%) reported behaving aggressively toward their infant. Participants who reported UITs of intentional, infant-related harm (44.4%; 95% CI, 39.2% to 49.7%) were not more likely to report aggression toward their newborn compared with women who did not report this ideation (2.6%; 95% CI, 0.9% to 5.8%; and 3.1%; 95% CI, 1.3% to 6.2%, respectively). The same was true for women with and without OCD (1.9%; 95% CI, 0.3% to 6.4%; and 3.5%; 95% CI, 1.8% to 6.0%), respectively.Conclusions: This study found no evidence that the occurrence of either UITs of intentional, infant-related harm or OCD is associated with an increased risk of infant harm. The prevalence of child abuse of infants in this sample (2.9%) is lower than reported in others (4%-9%). Findings provide critical and reassuring information regarding the relation between new mothers' UITs of intentional harm and risk of physical violence toward the infant.

Refining our understanding of depressive states and state transitions in response to cognitive behavioural therapy using latent Markov modelling.

BACKGROUND: It is increasingly recognized that existing diagnostic approaches do not capture the underlying heterogeneity and complexity of psychiatric disorders such as depression. This study uses a data-driven approach to define fluid depressive states and explore how patients transition between these states in response to cognitive behavioural therapy (CBT). METHODS: Item-level Patient Health Questionnaire (PHQ-9) data were collected from 9891 patients with a diagnosis of depression, at each CBT treatment session. Latent Markov modelling was used on these data to define depressive states and explore transition probabilities between states. Clinical outcomes and patient demographics were compared between patients starting at different depressive states. RESULTS: A model with seven depressive states emerged as the best compromise between optimal fit and interpretability. States loading preferentially on cognitive/affective v. somatic symptoms of depression were identified. Analysis of transition probabilities revealed that patients in cognitive/affective states do not typically transition towards somatic states and vice-versa. Post-hoc analyses also showed that patients who start in a somatic depressive state are less likely to engage with or improve with therapy. These patients are also more likely to be female, suffer from a comorbid long-term physical condition and be taking psychotropic medication. CONCLUSIONS: This study presents a novel approach for depression sub-typing, defining fluid depressive states and exploring transitions between states in response to CBT. Understanding how different symptom profiles respond to therapy will inform the development and delivery of stratified treatment protocols, improving clinical outcomes and cost-effectiveness of psychological therapies for patients with depression.

Comorbid obsessive-compulsive disorder in individuals with eating disorders: An epidemiological meta-analysis.

The present study aimed to provide a precise, meta-analytic estimate of the prevalence of obsessive-compulsive disorder (OCD) amongst those with a current primary eating disorder (ED) diagnosis, and to isolate its predictors. An online search of PubMed and PsycINFO was conducted with a Boolean search phrase incorporating keywords related to OCD, EDs, comorbidity, prevalence, and epidemiology, complemented by references coded from related review articles and contact with experts in the field. Articles were included if they (a) reported an observational study examining current ED diagnoses, (b) used a semi-structured or structured diagnostic interview for OCD and ED diagnosis, (c) applied DSM or ICD criteria, (d) included adolescent or adult samples (age > 12), (e) included patient or community samples, and (f) reported lifetime or current OCD comorbidity. From the 846 articles identified, 35 lifetime and 42 current estimates were calculated. OCD prevalence was extracted from each study for each ED diagnostic category, along with eleven additional potential moderators. Analyses revealed an aggregate lifetime OCD prevalence of 13.9% CI95% [10.4 to 18.1] and current OCD prevalence of 8.7% CI95% [5.8 to 11.8] across EDs. Moderator analyses revealed the prevalence of and risk for OCD in EDs to be greatest in anorexia nervosa binge-eating purging type (ANBP). Further, OCD is most prevalent amongst patient samples than samples recruited from the community.

Neural correlates of the production effect: An fMRI study.

Recognition memory is improved for items produced at study (e.g., by reading them aloud) relative to a non-produced control condition (e.g., silent reading). This production effect is typically attributed to the extra elements in the production task (e.g., motor activation, auditory perception) enhancing item distinctiveness. To evaluate this claim, the present study examined the neural mechanisms underlying the production effect. Prior to a recognition memory test, different words within a study list were read either aloud, silently, or while saying "check" (as a sensorimotor control condition). Production improved recognition, and aloud words yielded higher rates of both recollection and familiarity judgments than either silent or control words. During encoding, fMRI revealed stronger activation in regions associated with motor, somatosensory, and auditory processing for aloud items than for either silent or control items. These activations were predictive of recollective success for aloud items at test. Together, our findings are compatible with a distinctiveness-based account of the production effect, while also pointing to the possible role of other processing differences during the aloud trials as compared to silent and control.

Emotional memories are (usually) harder to forget: A meta-analysis of the item-method directed forgetting literature.

The current meta-analysis explored whether emotional memories are less susceptible to item-method directed forgetting than neutral memories. Basic analyses revealed superior memory for remember (R) than forget (F) items in both the neutral, M = 19.6%, CI95% [16.1, 23.1], and the emotional, M = 15.1%, CI95% [12.4, 17.7], conditions. Directed forgetting in either valence condition was larger for (a) words than for other stimuli; (b) recall than recognition tests; (c) studies that used recall prior to recognition testing; (d) shorter lists; and (e) studies that included buffer items. Direct comparison of the magnitude of the directed forgetting effect across neutral and emotional conditions within studies revealed relatively diminished directed forgetting of emotional items compared to neutral items, with an average difference of 4.2%, CI95% [2.0, 6.4]. However, the nature of this finding varied broadly across studies, meaning that whether - and to what degree - emotional memories are more resilient than neutral memories likely depends on the methodological features of the study in question. Moderator analyses revealed larger differences (a) in studies for which the emotional items were more arousing than the neutral items, and (b) when buffer items were included. Together, these findings suggest that emotional memories are often more resilient to intentional forgetting than neutral memories, although further research is necessary to characterize the circumstances under which these differences emerge.

Factors associated with cognitive impairment during the first year of treatment for nonmetastatic breast cancer.

BACKGROUND: Women with breast cancer are more likely to develop cognitive impairment (CI), insomnia, fatigue, and mood disturbance than individuals with other cancers. The main objectives of this study were to establish the prevalence of CI and examine the relationships between CI, insomnia, fatigue, and mood over the first year of breast cancer treatment. METHODS: Participants were recruited after diagnosis and completed validated measures of insomnia, objective and perceived CI, fatigue, and mood disturbance at four time points during the first year of treatment. A random intercepts cross-lagged panel model assessed relationships among symptoms over time. RESULTS: The sample included 98 women. Prevalence of objective CI ranged from 3.1% to 8.2% throughout the year, whereas 36.7% demonstrated a clinically meaningful decline in perceived CI from baseline to 4 months, which remained relatively stable. Greater perceived CI was associated with more fatigue (ß = -0.78, z = 17.48, p < .01) and symptoms of insomnia (ß = -0.58, z = 5.24, p < .01). Short-term fluctuations in perceived CI (p < .05), but not fatigue or insomnia, predicted future perceived CI. Fatigue (p < .001) was a significant predictor of future reported symptoms of fatigue and insomnia. CONCLUSION: Subjective CI is more prevalent than objective impairments. Fatigue, insomnia, and perceived CI remain stable and are associated during the first year of treatment. Changes in insomnia and fatigue may have little effect on future perceived cognition. Women with breast cancer likely require targeted intervention for these side effects.

Memory suppression and its deficiency in psychological disorders: A focused meta-analysis.

It is still debated whether suppressing the retrieval of unwanted memories causes forgetting and whether this constitutes a beneficial mechanism. To shed light on these 2 questions, we scrutinize the evidence for such suppression-induced forgetting (SIF) and examine whether it is deficient in psychological disorders characterized by intrusive thoughts. Specifically, we performed a focused meta-analysis of studies that have used the think/no-think procedure to test SIF in individuals either affected by psychological disorders or exhibiting high scores on related traits. Overall, across 96 effects from 25 studies, we found that avoiding retrieval leads to significant forgetting in healthy individuals, with a small to moderate effect size (0.28, 95% CI [0.14, 0.43]). Importantly, this effect was indeed larger than for more anxious (-0.21, 95% CI [-0.41, -0.02]) or depressed individuals (0.05, 95% CI [-0.19, 0.29])-though estimates for the healthy may be inflated by publication bias. In contrast, individuals with a stronger repressive coping style showed greater SIF (0.42, 95% CI [0.32, 0.52]). Furthermore, moderator analyses revealed that SIF varied with the exact suppression mechanism that participants were instructed to engage. For healthy individuals, the effect sizes were considerably larger when instructions induced specific mechanisms of direct retrieval suppression or thought substitution than when they were unspecific. These results suggest that intact suppression-induced forgetting is a hallmark of psychological well-being, and that inducing more specific suppression mechanisms fosters voluntary forgetting. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Women Are at Greater Risk of OCD Than Men: A Meta-Analytic Review of OCD Prevalence Worldwide.

OBJECTIVE: To estimate the worldwide prevalence of obsessive-compulsive disorder (OCD), examine whether women are at greater risk than men, and explore other potential moderators of OCD prevalence to explain variability in community-based epidemiologic studies. DATA SOURCES: An electronic search of PsycINFO and PubMed was conducted until January 2017, without date or language restrictions, using the keywords OCD, epidemiology, and prevalence. The search was supplemented by articles referenced in the obtained sources and relevant reviews. STUDY SELECTION: Studies were included if they reported current, period, and/or lifetime OCD prevalence (diagnosed according to an interview based on DSM or ICD criteria) in representative community samples of adults aged 18 years or older. A total of 4,045 studies were retrieved, with 34 studies ultimately included. DATA EXTRACTION: OCD prevalence was extracted from each study alongside 9 moderators: gender, year, response rate, region, economic status, diagnostic criteria, diagnostic interview, interviewer, and age. RESULTS: The overall aggregate current, period, and lifetime OCD prevalence estimates were 1.1%, 0.8%, and 1.3%, respectively. In a typical sample, women were 1.6 times more likely to experience OCD compared to men, with lifetime prevalence rates of 1.5% in women and 1.0% in men. There was also a trend toward younger adults' being more likely to experience OCD in their lifetime than older adults. All findings demonstrated moderate heterogeneity. CONCLUSIONS: Women are typically at greater risk of experiencing OCD in their lifetime than men.

Distinctive encodings and the production effect: failure to retrieve distinctive encodings decreases recollection of silent items.

Studies have shown that when aloud and silent items are studied together, silent items are remembered more poorly than when they are studied independently. We hypothesise that this cost to silent items emerges because, at test, participants search for memories of having said items aloud and when those memory searches fail, participants become uncertain about whether silent items were studied. This effect should be exaggerated if other unique distinctive encoding conditions are also included at study (e.g., mumbling, writing, typing, etc.). To test this prediction, we examined the impact of introducing mumbled, "important" (i.e., words that participants are told are the most important to remember), and mouthed words to a study list of aloud and silent words. Introducing mumbled and "important" words further impaired the recollection of silent items. Introducing mouthed items did not further impair the memorability of silent items because mouthing and speaking aloud are so similar and hence, are not fully unique from each other. The memorability of aloud items was unaffected in all conditions. These results suggest that participants search for distinctive encoding information at test, and only for items that fail those searches (i.e., silent items) do they lose confidence.

The Prevalence of Anxiety Disorders During Pregnancy and the Postpartum Period: A Multivariate Bayesian Meta-Analysis.

OBJECTIVE: To estimate the prevalence of anxiety disorders in pregnant and postpartum women and identify predictors accounting for variability across estimates. DATA SOURCES: An electronic search of PsycINFO and PubMed was conducted from inception until July 2016, without date or language restrictions, and supplemented by articles referenced in the obtained sources. A Boolean search phrase utilized a combination of keywords related to pregnancy, postpartum, prevalence, and specific anxiety disorders. STUDY SELECTION: Articles reporting the prevalence of 1 or more of 8 common anxiety disorders in pregnant or postpartum women were included. A total of 2,613 records were retrieved, with 26 studies ultimately included. DATA EXTRACTION: Anxiety disorder prevalence and potential predictor variables (eg, parity) were extracted from each study. A Bayesian multivariate modeling approach estimated the prevalence and between-study heterogeneity of each disorder and the prevalence of having 1 or more anxiety disorder. RESULTS: Individual disorder prevalence estimates ranged from 1.1% for posttraumatic stress disorder to 4.8% for specific phobia, with the prevalence of having at least 1 or more anxiety disorder estimated to be 20.7% (95% highest density interval [16.7% to 25.4%]). Substantial between-study heterogeneity was observed, suggesting that "true" prevalence varies broadly across samples. There was evidence of a small (3.1%) tendency for pregnant women to be more susceptible to anxiety disorders than postpartum women. CONCLUSIONS: Peripartum anxiety disorders are more prevalent than previously thought, with 1 in 5 women in a typical sample meeting diagnostic criteria for at least 1 disorder. These findings highlight the need for anxiety screening, education, and referral in obstetrics and gynecology settings.