Evaluation of delay discounting as a transdiagnostic research domain criteria indicator in 1388 general community adults.

BACKGROUND: The Research Domain Criteria (RDoC) approach proposes a novel psychiatric nosology using transdiagnostic dimensional mechanistic constructs. One candidate RDoC indicator is delay discounting (DD), a behavioral economic measure of impulsivity, based predominantly on studies examining DD and individual conditions. The current study sought to evaluate the transdiagnostic significance of DD in relation to several psychiatric conditions concurrently. METHODS: Participants were 1388 community adults (18-65) who completed an in-person assessment, including measures of DD, substance use, depression, anxiety, posttraumatic stress disorder, and attention-deficit hyperactivity disorder (ADHD). Relations between DD and psychopathology were examined with three strategies: first, examining differences by individual condition using clinical cut-offs; second, examining DD in relation to latent psychopathology variables via principal components analysis (PCA); and third, examining DD and all psychopathology simultaneously via structural equation modeling (SEM). RESULTS: Individual analyses revealed elevations in DD were present in participants screening positive for multiple substance use disorders (tobacco, cannabis, and drug use disorder), ADHD, major depressive disorder (MDD), and an anxiety disorder (ps < 0.05-0.001). The PCA produced two latent components (substance involvement v. the other mental health indicators) and DD was significantly associated with both (ps < 0.001). In the SEM, unique significant positive associations were observed between the DD latent variable and tobacco, cannabis, and MDD (ps < 0.05-0.001). CONCLUSIONS: These results provide some support for DD as a transdiagnostic indicator, but also suggest that studies of individual syndromes may include confounding via comorbidities. Further systematic investigation of DD as an RDoC indicator is warranted.

Consistent evidence of indirect effects of impulsive delay discounting and negative urgency between childhood adversity and adult substance use in two samples.

RATIONALE: Exposure to adverse life experiences (ACEs) is robustly associated with problematic alcohol and other drug use. In addition, both ACEs and substance use have been independently associated with impulsivity. OBJECTIVE: To examine whether impulsivity is implicated in the link between ACE and adult substance use in two samples. METHODS: The primary sample was a cohort of community adults (N = 1431) who completed a one-time in-person assessment. A second sample was crowdsourced using Amazon Mechanical Turk (N = 3021). All participants were assessed for ACEs using the Adverse Childhood Experience Questionnaire and for current alcohol and other drug use. Given its multidimensional nature, impulsivity was assessed using the UPPS-P measure of impulsive personality traits, Go/NoGo (GNG) task (in-person community adult sample only), and delay discounting (Monetary Choice Questionnaire [MCQ] in the community adults and Effective Delay-50 [ED50] in the crowdsourced sample. Structural equation modeling was used to examine the hypothesized indirect effects for the measures of impulsivity between ACEs and substance use. RESULTS: In the community adults, significant indirect effects were observed from ACEs to substance use via UPPS-Negative Urgency (ß = 0.07, SE = 0.02, 95% CI [0.04, 0.10]), and the MCQ (ß = 0.02 SE = .01, 95% CI [0.01, 0.03]). In the crowdsourced sample, significant indirect effects were observed from ACEs to substance use via UPPS-Negative Urgency (ß = 0.05, SE = .01, 95% CI [0.04, 0.07]), UPPS-Premeditation (ß = 0.04, SE = .01, 95% CI [0.02, 0.05), and the ED50 (ß = 0.02, SE = .01; 95% CI [0.01, 0.03]). CONCLUSION: These findings provide consistent evidence that decrements in regulation of negative emotions and overvaluation of immediate rewards indirectly link ACE and substance use. These robust cross-sectional findings support the need for elucidating the underlying neural substrates implicated and for longitudinal evaluations.

Optimizing screening for depression, anxiety disorders, and post-traumatic stress disorder in inpatient addiction treatment: A preliminary investigation.

OBJECTIVE: Substance use disorders (SUD) are frequently comorbid with other psychiatric conditions, but a comprehensive diagnostic assessment is often not feasible clinically. Efficient psychometrically-validated screening tools exist for commonly comorbid conditions, but cutoff accuracies have typically not been evaluated in addiction treatment settings. This study examined the performance of several widely-used screening measures in relation to diagnostic status from a clinical interview to identify and validate cutoff scores in an inpatient SUD treatment setting. METHOD: Participants were 99 patients in a large residential SUD treatment program in Ontario, Canada. Participants completed a screening battery, including the Patient Health Questionnaire - 9 (PHQ-9), Generalized Anxiety Disorder - 7 (GAD-7), and Post-Traumatic Stress Disorder Checklist-5 (PCL-5), and underwent a semi-structured diagnostic clinical interview. Receiver operating characteristic curves were used to determine optimal cutoff scores on the screening tool against the interview-based diagnosis. RESULTS: Area under the curve (AUC) was statistically significant for all screens and were as follows: PHQ-9 = 0.70 (95% CI = 0.59-0.80), GAD-7 = 0.74 (95% CI = 0.63-0.84), and PCL-5 = 0.79 (95% CI = 0.66-0.91). The optimal accuracy cutoff scores based on sensitivity and specificity were: PHQ-9 ≥ 16, GAD-7 ≥ 9, the PCL-5 ≥ 42. CONCLUSIONS: In general, the candidate screeners performed acceptably in this population. However, the optimal cutoff scores were notably higher than existing guidelines for depression and PTSD, potentially due to the general elevations in negative affectivity among individuals initiating SUD treatment. Further validation of these cutoff values is warranted. PUBLIC HEALTH SIGNIFICANCE: This study provides modified screening cutoff scores for major depression, anxiety disorders, and post-traumatic stress disorder in addiction treatment settings.

Phosphorylation-deficient G-protein-biased µ-opioid receptors improve analgesia and diminish tolerance but worsen opioid side effects.

Opioid analgesics are powerful pain relievers; however, over time, pain control diminishes as analgesic tolerance develops. The molecular mechanisms initiating tolerance have remained unresolved to date. We have previously shown that desensitization of the µ-opioid receptor and interaction with ß-arrestins is controlled by carboxyl-terminal phosphorylation. Here we created knockin mice with a series of serine- and threonine-to-alanine mutations that render the receptor increasingly unable to recruit ß-arrestins. Desensitization is inhibited in locus coeruleus neurons of mutant mice. Opioid-induced analgesia is strongly enhanced and analgesic tolerance is greatly diminished. Surprisingly, respiratory depression, constipation, and opioid withdrawal signs are unchanged or exacerbated, indicating that ß-arrestin recruitment does not contribute to the severity of opioid side effects and, hence, predicting that G-protein-biased µ-agonists are still likely to elicit severe adverse effects. In conclusion, our findings identify carboxyl-terminal multisite phosphorylation as key step that drives acute µ-opioid receptor desensitization and long-term tolerance.

An ethical dilemma in school nursing.

School nurses must consider the ethical principles that guide everyday practice. Autonomy, beneficence, justice, and nonmaleficence are the ethical principles most often confronted in the school setting. When beneficent care-giving begins to conflict with the family's decision-making autonomy, paternalism, a form of beneficence, affects the family's autonomy. This creates an ethical dilemma for the school nurse who guides his or her practice by ethical principles but who also must decide when it is appropriate to refer a child or family to a medical provider for further evaluation. A case study is presented to illustrate a specific ethical dilemma. The ethical dilemma is described using a model that examines external factors, professional responsibilities, and possible courses of action. The discussion includes cultural considerations and barriers pertinent to the case example.

Utilization of home-delivered meals by recipients 75 years of age or older.

OBJECTIVE: To compare the effects of gender, age, and living situation on utilization of home-delivered meals by elderly recipients. DESIGN: Cross-sectional cohort study. SETTING: The sample was recruited from five meals-on-wheels agencies in southern Ontario, Canada, representing both rural and urban settings. SUBJECTS: Participants were 150 white, independently living recipients of meals-on-wheels who were older than 75 years and able to communicate in English and who had access to a telephone. Of these, 137 (90 women and 47 men) completed the study (attrition rate = 9%). MAIN OUTCOME MEASURES: Meal utilization: the energy and nutrient content and the amounts of specific foods in the consumed portions of delivered meals calculated as percentages of the total received from the service agencies. STATISTICAL ANALYSES PERFORMED: Two-factor analysis of variance. RESULTS: Meal utilization in terms of energy of the consumed portion of the delivered meals was 81 +/- 18%. Nutrient utilization ranged from 83% (vitamin A) to 77% (vitamin C). For specific foods, utilization ranged from 67% (miscellaneous) to 83% (protein sources and soups). Utilization levels for energy, eight nutrients, and specific foods were significantly higher for men than for women. Women living alone showed higher utilization values for energy and 11 nutrients compared with those living with others. Age had no effect on meal utilization. CONCLUSIONS: Monitoring and consultation procedures are necessary to ensure maximum nutritional benefits to clients and cost-effectiveness of the meal service.

Some additional light on the childhood sexual abuse-psychopathology axis.

This exposition is an attempt to unravel the complexities of the relationship between childhood sexual abuse and adult psychopathology. Four facets of the relationship are examined in some detail: (a) the extent of childhood sexual abuse; (b) the probability that sexual abuse in childhood will result in psychopathology in the adult; (c) the reliability of early life memories in later life; and (d) the role of recovered memory of trauma in the healing process. The conclusions of this logico-empirical analysis are that first, government statistics tend to underestimate the extent of childhood sexual abuse, whereas independent surveys tend to overestimate it. Estimating prevalence is further complicated by variations in the definitions of key terms. Possibly the only safe conclusion is that true prevalence cannot be reliably determined. Second, empirical investigations of childhood sexual abuse conclude that not all victims are emotionally injured. A substantial number of these investigations find that a majority of victims suffer no extensive harm. Other variables such as family dynamics are involved; there may be only a few cases in which emotional harm results from sexual abuse as a single factor. Third, memory research suggests that memory in general is a dynamic, reconstructive process and that recall of childhood events is particularly vulnerable to distortion. Memory cannot dependably produce historical truth. Last, there is some clinical evidence that abreaction of a traumatic event in adulthood may have a remediative effect. Similar evidence for childhood trauma is lacking. The belief in the healing effect of recalling and reliving a childhood trauma depends on the therapist's orientation.

The effect of intracavernosal injection of papaverine hydrochloride on orgasm latency.

The research literature on the employment of various vasoactive drugs to induce penile erection has largely examined assessment and treatment techniques. One study specifically examined the duration of erection, or "orgasm latency," of the drug-induced erection. However, it did not determine the relation of this duration to pre-impotence duration. The intent of the present investigation was to make this determination. Subjects at a urology department impotence clinic were asked to estimate orgasm latency prior to impotence and with papaverine-induced erection. The mean orgasm latency prior to impotence was 9.9 minutes; with papaverine, 15 minutes. It is concluded that papaverine injection not only causes an erection but makes it last longer than naturally occurring erections.

The prevalence and some attributes of females in the sadomasochistic subculture: a second report.

Nonprostitute women in the sadomasochism (S/M) subculture have been believed to be rare. A sample of 45 women from the S/M subculture of whom 34 were determined to be nonprostitutes was obtained. This sample is compared with a similar sample obtained by Breslow et al. (1985). Despite methodological differences between the present investigation and that of Breslow et al., interstudy similarities permit conclusions about women in the S/M subculture in addition to the fact that they occur with sufficient frequency to study. The women become aware of their orientation as young adults and most are satisfied with it. They tend to be better educated and less often married than the general population. A majority designate themselves as heterosexual but a substantial minority are bisexual. They tend more often to prefer the submissive role but preference for the dominant role or no preference are found with considerable frequency. Oral sex and bondage are favored activities.

The effect of MMPI-2 on scoring of special scales derived from MMPI-1.

Twenty-nine special scales derived from the Minnesota Multiphasic Personality Inventory (MMPI-1; Hathaway & McKinley, 1983) were scored from MMPI-I and MMPI++-2 (Hathaway et al., 1989) items for a normal and a psychiatric sample. Resulting pairs of mean scores were compared. Absolute differences were found to be small but statistically significant. We concluded that, despite the statistical significance, the small absolute differences suggest that most of the MMPI-I special scales probably can be scored and interpreted from MMPI-2 items. Further research along this line is necessary.

Hypnotically induced auditory hallucinations and the mouth-opening maneuver: a failure to duplicate findings.

OBJECTIVE: The authors sought to replicate the part of a study by Bick and Kinsbourne in which hypnotically induced auditory hallucinations in normal volunteer subjects were abolished by requiring the subjects to open their mouths. METHODS: Sixty-four normal volunteer subjects were hypnotized, and an attempt was made to induce auditory hallucinations. The subjects in whom hallucinations were successfully induced were then asked to perform the mouth-opening maneuver and the control maneuvers of putting their fingers in their ears or squeezing their eyes shut in an effort to end the hallucinations. RESULTS: Sixteen subjects reported having hallucinations. None of them reported that a hallucination was abolished by opening the mouth or closing the eye; four reported ending hallucinations by putting their fingers in their ears. CONCLUSIONS: Opening the mouth does not affect auditory hallucinations induced by hypnosis in normal persons. The most likely reason for the discrepancy between the results of this experiment and those of the Bick and Kinsbourne study is that the design of the latter study was faulty because it permitted demand characteristics to influence the results.

Some conditions of compliance and resistance among hypnotic subjects.

Five experimental approaches to the resolution of the century-old Bernheim/Janet dispute and the issue of involuntariness or coercion (the classical suggestion effect) are presented. Four experiments are reported that follow one of the approaches: attempts to induce hypnotic subjects to resist suggestions made in trance. The design is one in which a "resistance instructor" proposes a reward for the resisting subject. Tentative inferences from the results are that the classical suggestion effect is found with a small number of subjects; for a larger number of subjects there is no classical suggestion effect, and for many subjects the outcome is equivocal. Relational factors in the hypnotic dyad influence responsiveness in the subject, the effect being least for those whose susceptibility is high.

A reversal of hypnotically "refreshed" testimony: a brief communication.

A case is briefly presented in which questioning under hypnosis led to a positive identification of an accused rapist when the victim had previously been uncertain. During the trial, the victim was first certain, then reverted to her prehypnotic uncertainty. An appeal from the conviction of the defendant was denied on the grounds that the witness' uncertainty meant that the hypnotic intervention was harmless error. It is possible that this decision may not be entirely justified.

The hypnotic relationship: an investigation of compliance and resistance.

The purpose of this investigation was to assess the ability of hypnotic Ss to voluntarily resist a neutral suggestion when a monetary reward is offered for resistance. 19 of 40 Ss (47.5%) successfully resisted after money was offered by the "resistance instructor." The correlation between resistance/compliance and hypnotizability was -.44 (high hypnotizables were more likely to comply). Ss' impressions of the hypnotist tended to be positive; impressions of the resistance instructor tended to be neutral. There was a tendency for nonresistors to have a more positive view of the hypnotist but it is not as marked as was found in an earlier study (Levitt & Baker, 1983).

Relationships among intravaginal pressure, orgasmic function, parity factors, and urinary leakage.

Women's ability to contract pelvic musculature voluntarily was related to reports of ability to have orgasm, parity, and urinary leakage problems. Data collected from 92 women presenting for routine pelvic examinations provided no evidence of a general relationship between strength of voluntary pelvic muscle contractions and orgasmic function. There were negative relationships between strength of voluntary pelvic muscle contractions and parity, weight of the largest baby, and a woman's age.

Estimating the duration of sexual behavior: a laboratory analog study.

Estimate of male orgasm latency, a common parameter of the sex history, is hypothetically subject to retrospective distortion. This investigation attempted to assess the degree and direction of the distortion using a laboratory analog procedure. Groups of sophomore medical students were shown a movie depicting a couple engaging in continuous foreplay and coitus. About half were asked to estimate the length of the foreplay and coitus periods in minutes. The other half were required to judge whether time periods were average, below average, or above average in duration for people of their own age. Subjects tended to overestimate the length of the coitus period in the film, but not the foreplay period. Females tended to estimate both periods as significantly longer than males. Nearly half of the group judged the foreplay period to be average, and over 60% judged the coital period to be average. Less than 23% thought that the coital period was below average. Married subjects tended to regard both time periods as above average, compared to single subjects. A possible inference from this investigation is that the mean young adult male orgasm latency is probably in the range of 2-3 minutes.