A pilot study augmenting cognitive behavioral therapy for panic disorder with attention bias modification: Clinical and psychophysiological outcomes.

BACKGROUND AND OBJECTIVES: Studies show that attentional bias towards threat is a key maintenance factor for panic disorder (PD). Attentional bias may be an important mechanism of symptom reduction, and thus, a useful target for optimizing outcomes. The current study examined whether an attention bias modification (ABM) task enhanced CBT outcomes. Multiple methods for assessing PD were used, including physiological measurement and clinician-rated assessment. METHODS: Adults with panic disorder (N = 24) received seven sessions of CBT with either ABM or sham attention tasks. Psychophysiological reaction to a loud tones startle paradigm was assessed before and after treatment. RESULTS: Across both groups, panic symptom severity decreased with CBT. The ABM group showed greater reductions in PD symptoms compared to the placebo group. Notably, however, changes in attentional bias were not associated with symptom reductions across groups. No significant group differences on psychophysiological assessment were observed. LIMITATIONS: This study is limited by the small sample size, which rendered our power to investigate mediators and moderators insufficient. More research is needed to validate the effect of attention bias modification on attentional bias to threat. CONCLUSIONS: This pilot study suggests that future research should investigate attentional bias in conjunction with CBT. A larger sample would provide opportunity to further investigate the mechanisms through which ABM works, along with potential moderating factors and the use of psychophysiological measurements in panic disorder.

The role of anxiety sensitivity in sleep disturbance in panic disorder.

Previous research has demonstrated that individuals with panic disorder (PD) report significant sleep disturbances, although the mechanism of this disturbance is not clear. Patients with PD tend to report abnormally high levels of anxiety sensitivity (AS). Because higher AS involves increases in attention and fearfulness about anxiety and associated physical sensations, which in turn may cause excessive psychological and physiologic arousal, we hypothesized that amongst individuals with PD, higher AS would be associated with sleep disruption, particularly in the form of increased sleep latency. As expected, PD was associated with poorer sleep as measured by the Global Pittsburgh Sleep Quality Index (PSQI) compared to controls and AS was significantly associated with longer sleep latency. Our data suggest that sleep disturbance, and in particular sleep latency, in PD may be partly due to high levels of AS, which can be targeted with cognitive-behavioral therapeutic strategies.

Computed tomography in the elderly: changes over time in a normal population.

The clinical, psychometric, and computed tomographic (CT) status of previously fit elderly volunteers is described at follow-up for up to four years. A number of relationships were found between psychometric and CT scores, but a dementing group could not be determined on the basis of a single scan. However, a subtle reduction in cognition over time was significantly related to CT changes, and occurred in 10%. Larger ventricles were also found in a small sub-group, who developed late-onset depressive disorders; recent bereavement was related to ventricular size. Thus a single CT scan may not be a useful discriminatory test in early dementia, but a repeat demonstrating ventricular enlargement, is likely to be significant. In the elderly, cognitive and CT scan deterioration should not be expected unless a disease process is occurring; this may be indicated by subtle cognitive impairment or by late-onset depressive disorder.

[CT study in dementia--today and in the future]. / CT-Untersuchung in der Demenz--heute und in der Zukunft.

The role of CT in the diagnosis of senile dementia of Alzheimer type (SDAT) is discussed. Research data show that, although SDAT is closely correlated with brain atrophy (sulcal and ventricular dilatation) there is a significant overlap with the normal elderly population: that is to say, within the demented population, CT changes correlate only weakly with cognitive impairment. However, taken together with other clinical indices, CT can be useful both for the assessment of SDAT and the exclusion of treatable lesions. Newer computer methods of analysis and technical improvements hold out hope for future clinical and research advances in this area.

Bouffée délirante: an examination of its current status.

Bouffée délirante is an historic and unique French diagnostic term for a short-lived psychosis. The key diagnostic features are acute, floridly psychotic symptoms with complete remission. Its use in a Paris hospital has been examined, and it appears that the term is declining in popularity. A case-controlled study indicated that the diagnosis is likely to be given to migrants on first admission. A re-diagnosis of case summaries indicated no particular correspondence of bouffée délirante to any one ICD category. However, the usefulness of having a special diagnostic term for psychosis with a good outcome is discussed.

Quantitative computed tomography in elderly depressed patients.

An index of brain tissue density was obtained from the CT scans of 37 elderly depressed patients by measuring Hounsfield Units (HU) in 12 predefined brain areas. Comparisons were made with 23 patients suffering from senile dementia and 36 healthy controls. As a group the depressed patients resembled the dements more than the controls, although analysis of variance indicated differences between all three groups, controls showing the highest HU values and dements the lowest. In the depressed patients ventricular dilatation, which had already been shown to predict increased mortality, was also associated with lower HU levels. The significance of these and other findings is discussed.

ECT and cerebral atrophy. A computed tomographic study.

The case-notes of 41 elderly depressives who underwent computed tomography were examined and the ECT history of each patient was assessed. No association was found between ECT and global cortical atrophy or ventricular size, but a significant relationship was demonstrated between frontal lobe atrophy and ECT.

Computed tomography and the outcome of affective disorder: a follow-up study of elderly patients.

Forty-one subjects from an earlier study, who had undergone computed tomography (CT) during their in-patient care for affective disorder, were followed up clinically for a minimum of one year. Mortality at two years was also determined, and comparisons made with 50 age-matched controls. Those with affective disorder showed a higher mortality than controls, but the difference just failed to reach significance. Within the affective group, however, mortality was significantly higher in patients who had previously shown ventricular enlargement on CT, confirming our earlier suggestion that these patients might have constituted a distinct subgroup. Failure of the affective group to improve performance on a simple cognitive test at follow-up was related to persisting depression. These and other findings are discussed.

Depression in the elderly.

The elderly are particularly susceptible to serious depressive illness. While physical disease and social deprivation might seem to explain this susceptibility there is still much to be learned about the aetiology, especially with regard to organic cerebral factors. Response to treatment in the short term is good, but the long-term outcome is one of high morbidity demanding an extensive commitment from psychiatric and social services.

Computed tomography in the elderly: I. The normal population.

Computed tomographic (CT) and brief psychometric findings on 50 psychiatrically and neurologically healthy community residents over 60 years old are presented. The need for normative CT data is emphasized, and the methodological problems in obtaining them are discussed. Measures of ventricular size were generally found to be greater than those reported by other workers, and variation with age was also found to be less marked than hitherto reported. A reciprocal relationship was found between a global rating of cortical atrophy and a test of memory and orientation. This communication forms the basis for comparison with groups of psychiatric patients to be presented in subsequent articles.

Computed tomography in the elderly. 2. Senile dementia: diagnosis and functional impairment.

Clinical, psychometric and computed tomographic (CT) data are presented on three groups of elderly subjects: 50 normals, 40 patients with senile dementia and 41 suffering from affective disorder. Demented subjects showed significantly more CT evidence of cerebral atrophy than non-demented subjects, but there was considerable overlap. Although patients with a history or clinical signs of cerebral infarction were specifically excluded, such infarcts were found moreoften in CT scans of the dementia subjects than in the others, particularly when the diastolic blood pressure was raised. When correlating cognitive impairment with CT changes, ventricular size emerged as more important in the dementia patients, in contrast to the controls, in whom cortical atrophy was related to lower scores on a cognitive test. Other interesting findings included an inverse relationship between cortical atrophy and paranoid delusions.

Computed tomography in the elderly. 3. Affective disorder.

Clinical and computed tomographic (CT) data on a consecutive series of 41 elderly patients with affective disorders are presented, and comparisons made with a group of 50 healthy controls. In both groups ventricular size increased with age, but only in the controls was there an age correlation with sulcal widening. Using clinical and radiological criteria, the prevalence of cerebrovascular disease in the patient group was 12 per cent. A sub-group of patients with enlarged ventricles emerged, whose first depression began later in life, and who at the time of this study were older and showed more "endogenous" features than the remainder. It is suggested that this provides further evidence that organic cerebral factors may have aetiological significance in some depressions of old age.