A self-report measure of subtle avoidance and safety behaviors relevant to social anxiety: development and psychometric properties.

According to cognitive theories, safety-seeking behaviors are crucial in both the maintenance and management of social anxiety. In order to facilitate assessment of these behaviors the Subtle Avoidance Frequency Examination (SAFE) was developed. Three factors emerged from the SAFE, which appeared to reflect active "safety" behaviors, subtle restriction of behavior, and behaviors aimed at avoiding or concealing physical symptoms. The SAFE demonstrated strong internal consistency, good construct validity and the ability to discriminate between clinical and non-clinical participants. In addition, the SAFE was responsive to the effects of treatment. Given its excellent psychometric properties, the SAFE may be useful to further investigate the role of safety strategies in social anxiety and to assess treatment outcomes.

Dendritic spine heterogeneity determines afferent-specific Hebbian plasticity in the amygdala.

Functional compartmentalization of dendrites is thought to underlie afferent-specific integration of neural activity in laminar brain structures. Here we show that in the lateral nucleus of the amygdala (LA), an area lacking apparent laminar organization, thalamic and cortical afferents converge on the same dendrites, contacting neighboring but morphologically and functionally distinct spine types. Large spines contacted by thalamic afferents exhibited larger Ca(2+) transients during action potential backpropagation than did small spines contacted by cortical afferents. Accordingly, induction of Hebbian plasticity, dependent on postsynaptic spikes, was restricted to thalamic afferents. This synapse-specific effect involved activation of R-type voltage-dependent Ca(2+) channels preferentially located at thalamic inputs. These results indicate that afferent-specific mechanisms of postsynaptic, associative Hebbian plasticity in LA projection neurons depend on local, spine-specific morphological and molecular properties, rather than global differences between dendritic compartments.

Characteristics of the GPCOG, a screening tool for cognitive impairment.

BACKGROUND: Early dementia diagnosis is aided by the use of brief screening tests; scores can be biased by patient and informant characteristics such as age, gender and education. OBJECTIVE: To assess whether the General Practitioner's Assessment of Cognition (GPCOG), a brief screening tool for detecting cognitive impairment comprising a patient cognitive test and questions to an informant, is biased by patient and informant characteristics. DESIGN: Sixty-seven general practitioners recruited consecutive patients (with informants). Patients were subsequently assessed by a research psychologist, and DSM-IV diagnoses assigned following a case-conference. SETTING: Primary Care. SUBJECTS: Two hundred and eighty three home-dwelling individuals, 11.3% of whom were aged 50-74 years with suspected memory problems and the rest aged 75 or more. METHODS: The GPCOG, Cambridge Mental Disorder of the Elderly Examination cognitive scale (CAMCOG), Geriatric Depression Scale (GDS), and the SF-12 Health Survey (SF-12) were administered and demographic data were collected and consensus DSM-IV diagnoses of dementia made. Relationships between patient and informant characteristics and the GPCOG measure were examined using Pearson correlations and linear regression analyses. RESULTS: There were correlations in GPCOG-patient scores with age, education and depression scores but on regression analysis only age was associated with the GPCOG-patient section. The GPCOG-informant section was free of bias. CONCLUSIONS: The GPCOG has advantages for use in primary care and is free of many biases common in other scales.

Diagnosing dementia in primary care: the accuracy of informant reports.

In the diagnosis of dementia, information obtained from informants or proxies is important; however, little is known about the circumstances under which informants' reports lack accuracy. This study compares informant reports of cognitive status against psychometric tests to identify the degree of, and factors associated with, discrepant reporting. Four areas of patient cognitive ability were examined: memory of recent events, ability to remember a short list of items after a delay, language/naming abilities, and working memory. Primary care practitioners recruited 248 community-dwelling patients aged 75 years or more or aged 50-74 years with suspected memory complaints; 248 friends or relatives acted as informants. More than half of the informants (60%) gave responses consistent with psychometric testing. Informants who underreported patient difficulties tended to report on patients who were diagnosed as having subclinical dementia, were less educated, and had poorer remote memory. Informants who overreported difficulties were more likely to report on those diagnosed with dementia. While informant accounts are critical for the assessment of dementia, we found that in 40% of cases these reports may be inaccurate, particularly when the patient has low education and poor remote memory or when overall cognitive difficulties are mild.

Differences in GABAergic transmission between two inputs into the perirhinal cortex.

We have investigated properties of GABAergic synaptic transmission in perirhinal cortex evoked by stimulation of temporal and entorhinal cortex sides. GABAA IPSCs were isolated by blockade of glutamatergic transmission in slices of adult perirhinal cortex; IPSC decay was best fitted with two exponentials. Interestingly, temporal IPSCs had a larger slow component of decay (P < 0.05) compared to entorhinal IPSCs. Depression of IPSCs by the GABAB receptor agonist baclofen was greater (P < 0.05) in the temporal input (79 +/- 4% depression) than the entorhinal input (65 +/- 3% depression). Furthermore, baclofen abolished the slow component of IPSC decay in both inputs. Activity-dependent depression of IPSCs at 5 Hz was greater (P < 0.05) in the temporal input [paired pulse ratio (PPR) 0.5 +/- 0.04] compared to that in the entorhinal input (PPR 0.67 +/- 0.02, n = 10). The differences in paired pulse depression between the inputs were removed by the GABAB receptor antagonist CGP55845A. This study demonstrates several differences in GABA transmission between temporal and entorhinal inputs including the differential activation of presynaptic GABAB receptors and differential regulation of inhibitory synaptic transmission. These properties may be important in the control of neuronal activity within perirhinal cortex.

The GPCOG: a new screening test for dementia designed for general practice.

OBJECTIVES: To design and test a brief, efficient dementia-screening instrument for use by general practitioners (GPs). DESIGN: The General Practitioner Assessment of Cognition (GPCOG) consists of cognitive test items and historical questions asked of an informant. The validity of the measure was assessed by comparison with the criterion standard of diagnoses of dementia derived from the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition). SETTING: Primary care doctors' offices. PARTICIPANTS: Sixty-seven GPs administered the GPCOG to 283 community-dwelling patients aged 50 to 74 with memory complaints or aged 75 and older. MEASUREMENTS: The Cambridge Mental Disorder of the Elderly Examination, the Abbreviated Mental Test (AMT), the Mini-Mental State Examination (MMSE), the 15-item Geriatric Depression Scale, and the 12-item Short-Form Health Survey. RESULTS: The GPCOG was reliable and superior to the AMT (and possibly to the MMSE) in detecting dementia. The two-stage method of administering the GPCOG (cognitive testing followed by informant questions if necessary)had a sensitivity of 0.85, a specificity of 0.86, a misclassification rate of 14%, and positive predictive value of 71.4%. Patient interviews took less than 4 minutes to administer and informant interviews less than 2 minutes. The instrument was reported by GPs to be practical to administer and was acceptable to patients. CONCLUSION: The GPCOG is a valid, efficient, well-accepted instrument for dementia screening in primary care.