The relationship of childhood sexual abuse and depression with somatic symptoms and medical utilization.

BACKGROUND: Previous research suggests that childhood sexual abuse is associated with high rates of retrospectively reported medical utilization and medical problems as an adult. The goal of this study was to determine if abused females have higher rates of medical utilization using self-report and objective measures, compared with non-abused females. A further goal was to determine whether findings of prior research would be replicated when childhood physical abuse level was controlled. This study also examined the moderating impact of depressed mood on current health measures in this population. METHODS: Six hundred and eight women recruited from a health maintenance organization completed self-report measures of health symptoms for the previous month and doctor visits for the previous year. Objective doctor records over a 2 year period were examined for a subset of 136 of these women. RESULTS: Results showed significantly more self-reported health symptoms and more self-reported doctor visits in abused participants compared with those who reported no childhood history of sexual abuse. Objective doctor visits demonstrated the same pattern with abused participants exhibiting more visits related to out-patient surgery and out-patient internal medicine. In addition, persons who were both sexually abused and depressed tended to visit the emergency room more frequently and to have more in-patient internal medicine and ophthalmology visits than sexually abused participants who reported low depressed mood and non-abused controls. CONCLUSIONS: These results replicate prior studies and suggest that current depression may moderate the relationship between sexual abuse and medical problems in adulthood.

Cognitive-behavioral treatment of pediatric obsessive-compulsive disorder: an open clinical trial.

OBJECTIVE: The purpose of this open clinical trial was to examine the efficacy of cognitive-behavioral treatment involving exposure and ritual prevention for pediatric obsessive-compulsive disorder (OCD). METHOD: Children and adolescents with diagnosed OCD (N = 14) received cognitive-behavioral treatment, seven patients received intensive treatment (mean = 18 sessions over 1 month) and seven received weekly treatment (mean = 16 sessions over 4 months). Eight of these patients received concurrent treatment with serotonin reuptake inhibitors and six received cognitive-behavioral treatment alone. Outcome was assessed via interviewer ratings on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Obsessive Compulsive Rating Scales for Main Fear and Main Ritual, and Hamilton Depression Rating Scale. RESULTS: Cognitive-behavioral treatment was effective in ameliorating OCD symptoms. Twelve of the 14 patients were at least 50% improved over pretreatment Y-BOCS severity, and the vast majority remained improved at follow-up; mean reduction in Y-BOCS was 67% at posttreatment and 62% at follow-up (mean time to follow-up = 9 months). CONCLUSIONS: Results suggest that cognitive-behavioral treatment by exposure and ritual prevention is effective for pediatric OCD. Controlled studies with random assignment to conditions are warranted to evaluate the relative efficacy of cognitive-behavioral pharmacological, and combined treatments.

Strategies of thought control in obsessive-compulsive disorder.

Intrusive anxiety-provoking thoughts are a core feature of obsessive-compulsive disorder (OCD). Recent research suggests that individuals use five different techniques of thought control including: distraction, punishment, re-appraisal, social control, and worry. The purpose of the present study was to examine the strategies of thought control used by OCD patients compared to those used by non-anxious controls. In addition, the relationship of method of thought control and domains of OCD-related psychopathology were investigated. Results revealed that OCD patients used punishment, worry, reappraisal, and social control more often than non-patients. Conversely, distraction was used more often by non-patients than OCDs. Interestingly, punishment was the strongest discriminator of OCDs and non-patients mostly because of the low frequency of its use by non-patients. Furthermore, punishment and worry were the only methods of thought control that correlated with OCD symptomatology. These results suggest that OCD patients may use maladaptive methods of thought control when faced with obsessions.

Change in rape narratives during exposure therapy for posttraumatic stress disorder.

This paper presents a coding system developed to explore changes in narratives of rape during therapy for posttraumatic stress disorder (PTSD) involving repeated reliving and recounting of the trauma. Relationships between narrative categories hypothesized to be affected by the treatment and treatment outcome were also examined. As hypothesized, narrative length increased from pre- to post-treatment, percentage of actions and dialogue decreased and percentage of thoughts and feelings increased, particularly thoughts reflecting attempts to organize the trauma memory. Also as expected, increase in organized thoughts was correlated negatively with depression. While indices of fragmentation did not significantly decrease during therapy, the hypothesized correlation between decrease in fragmentation and reduction in trauma-related symptoms was detected.

Role of hepatic flavin-containing monooxygenase 3 in drug and chemical metabolism in adult humans.

In conjunction with asymmetric chemical syntheses and spectral, chiroptical, chromatographic and stereochemical correlation methods, we have developed procedures for the quantification of sulfoxide enantiomers and tertiary amine N-oxide diastereomer metabolites arising from the action of the adult human liver and other flavin-containing monooxygenases (FMOs). The parallel nature of the metabolic in vitro-in vivo studies and the use of chemical model oxidation systems allowed us to identify the FMO isoform involved. We investigated the enantioselective S-monooxygenation of cimetidine and the diastereoselective tertiary amine N-1'-oxygenation of (S)-nicotine as stereoselective functional probes of adult human liver FMO action. In both cases, the majority of evidence points to adult human liver FMO3 as the principal enzyme responsible for cimetidine S-oxygenation and (S)-nicotine N-1'-oxygenation in vitro and in vivo. The excellent agreement between the absolute configuration of the major cimetidine S-oxide and (S)-nicotine N-1'-oxide metabolites isolated from human urine and the major metabolite formed in the presence of adult human liver microsomes suggests that in vitro hepatic preparations may serve as a useful model for the in vivo condition. Further, that adult human liver cDNA-expressed FMO3 in Escherichia coli also gave the same absolute stereoselectivity (i.e. for (S)-nicotine N-1'-oxygenation) confirms the identity of the monoxygenase in vivo. Although we cannot rule out the involvement of minor contributions of cytochrome P-450 monooxygenases in cimetidine and (S)-nicotine oxidation, the majority of the data support the fact that cimetidine S-oxygenation and (S)-nicotine N-1'-oxygenation are stereoselective functional probes of adult human liver FMO3 activity. Finally, because the stereochemistry of the principal metabolite of cimetidine and (S)-nicotine in small experimental animals is distinct from that observed in humans, it is likely that species variation in predominant FMO isoforms exist and this may have important consequences for the choice of experimental animals in human preclinical drug design and development programs.

Blocking in Pavlovian conditioning: effect of prior excitatory conditioning to a stimulus extraneous to compound conditioning.

The effect of prior excitatory conditioning to a stimulus not included in the compound conditioning phase of the typical blocking experiment was assessed in three CER studies. The first experiment, in which rat subjects received A+, C+, or a combination of A+/C+ trials prior to AB+ conditioning, showed that A+/C+ or C+ training produced as robust blocking as A+ training relative to a control group with no prior conditioning. A second experiment which was designed to assess the role of background cues in mediating the blocking effect indicated that background cues were not responsible for the A+ or C+ effects, while a third experiment showed these same effects were not mediated by stimulus generalization. The findings of these experiments are interpreted in the context of pseudoconditioning-induced rehearsal of a US representation in short-term memory.