A comprehensive analysis of the factor structure of the Beck Depression Inventory-II in a sample of outpatients with adjustment disorder and depressive episode.

OBJECTIVES: Despite being commonly used in research and clinical practice, the evidence regarding the factor structure of the Beck Depression Inventory-II (BDI-II) remains equivocal and this has implications on how the scale scores should be aggregated. Researchers continue to debate whether the BDI-II is best viewed as a unidimensional scale, or whether specific subscales have utility. The present study sought to test a comprehensive range of competing factor analytic models of the BDI-II, including traditional non-hierarchical multidimensional models and confirmatory bifactor models. METHOD: Participants (n=370) were clinical outpatients diagnosed with either depressive episode or adjustment disorder. Confirmatory factor analysis and confirmatory bifactor modelling were used to test 15 competing models. The unidimensionality of the best fitting model was assessed using three strength indices (explained common variance, percentage of uncontaminated correlations and ω hierarchical). RESULTS: Overall, bifactor solutions provided superior fit than both unidimensional and non-hierarchical multidimensional models. The best fitting model consisted of a general depression factor and three specific factors: cognitive, somatic and affective. High factor loadings and strength indices for the general depression factor supported the view that the BDI-II measures a single latent construct. CONCLUSIONS: The BDI-II should primarily be viewed as a unidimensional scale, and should be scored as such. Although it is not recommended that scores on individual subscales are used in isolation, they may prove useful in clinical assessment and/or treatment planning if used in conjunction with total scores.

Effects of a muscle-infecting parasitic nematode on the locomotor performance of their fish host.

The southern flounder Paralichthys lethostigma, host to the nematode Philometroides paralichthydis that is embedded in place of the inclinator muscles of the dorsal and anal fin elements, is hypothesized to impair two aspects of locomotor performance (swimming and burying capacity). Peak swimming acceleration and both measures of burying performance did not differ between infected and uninfected fish, whereas swimming velocity of infected fish was significantly lower than that of uninfected fish. Smaller infected fish swam at significantly slower speeds than smaller uninfected fish, whereas there was no difference among larger fish. Neither the location nor the number of worms affected either swimming or burying performance. The decrease in swimming velocity observed in smaller infected fish may be sufficient in rendering them more vulnerable to predation and environmental stressors.

Phase I trial of dolastatin-10 (NSC 376128) in patients with advanced solid tumors.

Dolastatin-10 (dola-10) is a potent antimitotic peptide, isolated from the marine mollusk Dolabela auricularia, that inhibits tubulin polymerization. Preclinical studies of dola-10 have demonstrated activity against a variety of murine and human tumors in cell cultures and mice models. The purpose of this Phase I clinical trial was to characterize the maximum tolerated dose, pharmacokinetics, and biological effects of dola-10 in patients with advanced solid tumors. Escalating doses of dola-10 were administered as an i.v. bolus every 21 days, using a modified Fibonacci dose escalation schema. Pharmacokinetic studies were performed with the first treatment cycle. Neurological testing was performed on each patient prior to treatment with dola-10, at 6 weeks and at study termination. Thirty eligible patients received a total of 94 cycles (median, 2 cycles; maximum, 14 cycles) of dola-10 at doses ranging from 65 to 455 microg/m2. Dose-limiting toxicity of granulocytopenia was seen at 455 microg/m2 for minimally pretreated patients (two or fewer prior chemotherapy regimens) and 325 microg/m2 for heavily pretreated patients (more than two prior chemotherapy regimens). Nonhematological toxicity was generally mild. Local irritation at the drug injection site was mild and not dose dependent. Nine patients developed new or increased symptoms of mild peripheral sensory neuropathy that was not dose limiting. This toxicity was more frequent in patients with preexisting peripheral neuropathies. Pharmacokinetic studies demonstrated a rapid drug distribution with a prolonged plasma elimination phase (t 1/2z = 320 min). The area under the concentration-time curve increased in proportion to administered dose, whereas the clearance remained constant over the doses studied. Correlation analysis demonstrated a strong relationship between dola-10 area under the concentration-time curve values and decrease from baseline for leukocyte counts. In conclusion, dola-10 administered every 3 weeks as a peripheral i.v. bolus is well tolerated with dose-limiting toxicity of granulocytopenia. The maximum tolerated dose (and recommended Phase II starting dose) is 400 microg/m2 for patients with minimal prior treatment (two or fewer prior chemotherapy regimens) and 325 microg/m2 for patients who are heavily pretreated (more than two prior chemotherapy regimens).

Chemotherapy for advanced esthesioneuroblastoma: the Mayo Clinic experience.

OBJECTIVE: Esthesioneuroblastoma (olfactory neuroblastoma) is a rare neuroendocrine tumor that arises in the upper nasal cavity from the olfactory epithelium. Little information is available regarding the treatment of these tumors with chemotherapy in the advanced setting. A retrospective review of patients with recurrent esthesioneuroblastoma treated with chemotherapy between 1970 and 1995 at the Mayo Clinic was undertaken to gain more information regarding the efficacy of chemotherapy treatment for these patients. METHODS: Ten patients were identified using a computerized data base available at this institution. The clinical and pathological materials, when available, were reviewed, and each tumor reviewed was assigned a Hyams' grade. RESULTS: There were six men and four women, ranging in age from 22 to 74 years, all of whom had assessable Kadish Stage C disease at the time of chemotherapy treatment. The chemotherapy regimens and clinical follow-up varied during this 25-year time span. The only tumor regression resultant from chemotherapy was observed in patients with high-grade tumors. Two of four patients with high-grade tumors obtained regression from first-line, platinum-based chemotherapy, with a mean duration of regression of 9.3 months (range, 2-13 mo). Survival time from initial diagnosis was 139.5 months (range, 83-168 mo) in patients with low-grade tumors and 32.2 months (range, 5-84 mo) in patients with high-grade tumors. Survival from initial chemotherapy treatment was 44.5 months (range, 3-130 mo) in patients with low-grade tumors and 26.5 months (range, 2-67 mo) in patients with high-grade tumors. CONCLUSION: Hyams' grading of esthesioneuroblastoma tumors seems to be important in predicting response to chemotherapy. Despite sensitivity to platinum-based chemotherapy, patients with high-grade tumors in this series had a much more aggressive course than did those with lower-grade tumors. This series suggests that cisplatin-based chemotherapy is active in advanced, high-grade esthesioneuroblastoma and is a reasonable choice in the systemic treatment of these patients.

Detection of monoclonal plasma cells in the peripheral blood of patients with primary amyloidosis.

We evaluated the blood from 150 patients with primary AL-amyloidosis for circulating monoclonal plasma cells using a sensitive slide-based immunofluorescence technique. The percentage of monoclonal blood plasma cells (BPC) that were in S-phase was determined by the bromodeoxyuridine labelling index (BLI). Monoclonal BPC were detected in 16% (24/150) of patients. The median number of monoclonal BPC was 1 x 10(6)/l and 4.6% (7/150) of patients had a high number. The BLI was zero in all but three patients. This study demonstrates that monoclonal plasma cells circulate in the peripheral blood of patients with AL-amyloidosis.

Systemic mast cell disease associated with the hypereosinophilic syndrome.

Systemic mast cell disease (SMCD) is an uncommon disorder characterized by a proliferation of mast cells involving the bone marrow, spleen, liver, skin, and lymph nodes. Although rare, the association of SMCD and other hematologic disorders is well established. To our knowledge, however, no previously published reports have described SMCD associated with the hypereosinophilic syndrome (HES). Herein we describe two patients who had SMCD in association with HES. Both patients had evidence of cardiac eosinophilic involvement, and both responded to systemic therapy. SMCD is often associated with eosinophilia and may be associated with HES more frequently than is commonly appreciated. Because congestive heart failure is a major cause of morbidity in patients with HES, cardiac assessment in patients with eosinophilia and SMCD is important in order to identify those with eosinophilic organ involvement and treat them aggressively.

A simplified approach to in vitro fertilization.

A simplified protocol for in vitro fertilization treatment was developed using low-dose clomiphene for ovarian stimulation, timing of human chorionic gonadotropin administration based solely on sonographic criteria, in-office egg retrieval and use of a simplified culture medium for embryo culture. Twenty-six infertile women underwent 39 treatment cycles, with 33 egg retrievals resulting in 29 embryo transfers. Clinical pregnancy was obtained in six patients (20.7% per embryo transfer), for a rate comparable to that achieved with conventional in vitro fertilization treatment in an age-matched control group. This simplification of in vitro fertilization treatment protocols can lead to decreased patient stress and costs without a substantially lower success rate.

Application of the skill acquisition model to the teaching of psychotherapy.

The variables in the Skill Acquisition Model (Dreyfus & Dreyfus, 1988) were used to order observations made in a graduate student clinical supervisory group. Components, perspective, decision, and commitment are the variables and are discussed as they relate to learning beginning skills in the psychotherapy process.

Effects of alcohol on reinforced repetitions and reinforced variations in rats.

Six rats were rewarded with food pellets for repeating a particular sequence of four responses on two levers, namely left-left-right-right. Ethanol (0.75 g/kg and 2.0 g/kg injected IP) increased the variability of sequences under these "repeat" contingencies, resulting in fewer rewarded trials. Six other rats were rewarded only if their sequence of left and right responses in the current trial differed from each of the previous five trials. Ethanol had little effect on sequence variability and no effect on reward probability under these "vary" contingencies. The relative difficulties of the repeat and vary tasks were manipulated to show that task difficulty did not account for the results. Thus alcohol increased or maintained behavioral variability, thereby impairing reinforced repetitions but not reinforced variations. When previously reported results from rats in radial arm mazes were compared with a simulated random model, alcohol was found to increase behavioral variability under that procedure as well.

Emotional and health impact of home monitoring on mothers: a controlled prospective study.

The psychologic and health effects of home monitoring were evaluated in mothers, whose infants (epidemiologically not at high risk for sudden infant death syndrome) were placed on electronic surveillance because of results obtained from a laboratory sleep study conducted at 4 weeks of age. Mothers of these infants were studied prospectively at several periods following the infants' births: 6 weeks, 12 weeks, and 1 year. The initial sample consisted of 56 mothers. Evaluation procedures included the Neonatal Perception Inventories, Anxiety Inventory (State and Trait), Depression Inventory, Brief Symptom Inventory, and a Recent Life Changes Questionnaire. The results obtained from these women were compared with those of women who had delivered at about the same time but whose infants were not placed on a home monitoring program. A total of 57 women started in the control group. Very few statistically significant group differences were observed between the two subject groups: 2 weeks after initiating the home monitoring program, monitor mothers (when compared to nonmonitor mothers) perceived their infant's behavior differently (although not more bothersome) and had an increased degree of situational anxiety (although not to an abnormal degree). There were no statistically significant differences between the two groups 12 weeks or 1 year after giving birth. These results suggest that a home monitoring program, which includes an aggressive and readily available support system, does not impose a marked health hazard to mothers.