Denise Bernier

Brief CBT for high anxiety sensitivity decreases drinking problems, relief alcohol outcome expectancies, and conformity drinking motives: Evidence from a randomized controlled trial

Background: High anxiety sensitivity (AS; fear of anxiety sensations) is associated with frequent and problem drinking (Stewart, Samoluk, & MacDonald, ). Aims: It was hypothesized that a program designed to reduce AS levels in young adult women would also result in a decrease in their dysfunctional drinking behavior. Method: The brief cognitive behavioral therapy (CBT) intervention was conducted in small group format. Participants were selected to form high and low AS groups, according to their scores on the Anxiety Sensitivity Index (ASI; Peterson & Reiss, ), and randomly assigned to participate in 3 one-hour sessions of either brief CBT (i.e., psycho-education, cognitive restructuring, and physical exercise interoceptive exposure) or a control group seminar (discussion about psychology ethics). Drinking measures were assessed at pre-treatment and 10 weeks post-intervention. Results: Following the intervention, high AS participants in the CBT condition revealed significant reduction in conformity motivated drinking and emotional relief expectancies, as well as a 50% reduction in proportion meeting criteria for hazardous alcohol use as compared to other three groups. Conclusion: Findings suggest that alcohol abuse might be effectively prevented among high risk individuals with a brief CBT approach targeting high AS, and that AS may operate as one underlying determinant of dysfunctional drinking behavior. Declaration of interests: None.

Review of psychodynamic psychotherapy neuroimaging studies.

The clinical efficacy of psychodynamic psychotherapy (PDT) has undergone extensive study and review. Recently, researchers have studied the effects of this treatment on brain metabolic or synaptic activity, but the collective findings have never been reviewed. The objective of this review was to describe the findings of all neuroimaging studies of any form of PDT treatment. An extensive literature search through databases along with surveying of research groups were undertaken to acquire all available published studies. Eleven series were included in the final sample, consisting of 2 randomized controlled trials, 5 controlled trials and 4 case series, altogether involving 210 people: 94 healthy controls and 116 people with mood disorders, panic disorder, somatoform disorders and borderline personality disorder. A variety of neuroimaging techniques were used to examine regional metabolic activity and synaptic neurotransmission before and after treatment. The common finding was normalization of synaptic or metabolic activity in limbic, midbrain and prefrontal regions, occurring in association with improved clinical outcomes. PDT has demonstrable effects on brain function in diverse clinical populations as evidenced by a modest group of mixed neuroimaging studies.

MRI-related anxiety levels change within and between repeated scanning sessions

Magnetic resonance imaging (MRI) scans frequently trigger state anxiety in individuals being scanned. It is not known, however, whether levels of MRI-related anxiety change over the course of a single scan or across repeated scanning experiences. Since changes in state anxiety are known to affect regional brain activity in healthy volunteers, systematic changes in levels of MRI-related anxiety could confound findings from neuroimaging studies. We assessed anxiety levels in eleven healthy male volunteers during a control period and during two MRI scanning sessions. Anxiety levels were highest during the first MRI scan, dropping to control levels or below by the second scan. In addition, anxiety fluctuated within scanning sessions, particularly during the first scan, with levels high at the beginning of the session, decreasing during mid-scan and then increasing again toward the end of the session. These results suggest that habituation in an MRI simulator before participating in a neuroimaging study could help to decrease fluctuations in MRI-related anxiety. Moreover, in studies that address several experimental questions within a single scanning session, experimental designs could be adapted to avoid potential confounds from within-scan variation in scanner-related anxiety.

White matter changes in early phase schizophrenia and cannabis use: An update and systematic review of diffusion tensor imaging studies

OBJECTIVES The impact of cannabis use on the brain tissue is still unclear, both in the healthy developing brain and in people with schizophrenia. The focus of this review is on white matter, the primary connective infrastructure of the brain. METHODS We systematically reviewed diffusion tensor imaging (DTI) studies of early phase schizophrenia (illness effect), of cannabis use in otherwise healthy brains (drug effect), and of early phase schizophrenia with cannabis use (combined effects). Studies had to include a healthy, non-cannabis using, control group as well as report on fractional anisotropy as it is the most commonly used DTI index. We excluded cohorts with heavy alcohol or illicit drug use and studies with a sample size of less than 20 in the clinical group. RESULTS We retained 17 studies of early phase schizophrenia, which together indicate deficits in white matter integrity observed in all fiber tract families, but most frequently in association, callosal and projection fibers. In otherwise healthy cannabis users (2 studies), deficits in white matter tracts were reported mainly in callosal fibers, but also in projection and limbic fibers. In cannabis users with early phase schizophrenia (1 study), deficits in white matter integrity were also observed in all fiber tract families, except for limbic fibers. CONCLUSIONS The current literature points to several families of white matter tracts being differentially affected in early phase schizophrenia. Further work is required to reveal the impact of cannabis use in otherwise healthy people as well as those with schizophrenia. LIMITATIONS Paucity of available studies as well as restricting analysis to FA values represent the main limitations of this review.

3-T proton magnetic spectroscopy in unmedicated first episode psychosis: a focus on creatine.

Different lines of evidence suggest an abnormal cerebral energy metabolism as being critical to the pathophysiology of schizophrenia. However, it is unknown as to whether levels of creatine (Cr) would be involved in these anomalies. The study involved 33 unmedicated first episode psychosis patients and 41 healthy controls. Proton magnetic resonance spectroscopy (1H‐MRS) was performed at 3 T using a long TE (TE/TM/TR of 240/27/3000 ms) such that within the total phosphocreatine (PCr) plus Cr signal (tCr240), mainly Cr was detectable. The target region was an 18 cm3 prefrontal volume. A negative association was found between age of patients and tCr240 levels referenced to internal water, with 20% of the variance in tCr240 accounted for by Age. A secondary finding revealed 16% reduction of tCr240 levels in patients, solely when comparing participants older than the median age of patients. No association existed between tCr240 levels and clinical variables. These findings support previous data reporting abnormalities in brain creatine kinase isoenzymes involved with the maintenance of energy pools in schizophrenia. The implications of using a long TE are discussed in terms of the relative proportions of Cr and PCr within the tCr240 signal, and of potential group differences in T2 times. Magn Reson Med, 2013.

Smaller volumes of caudate nuclei in prepubertal children with ADHD: impact of age.

OBJECTIVE Age-related abnormalities in caudate volumes have been reported to differ across the periods of childhood and puberty in children with ADHD. This study assessed caudate volumetric abnormalities across two narrow age clusters within the childhood period. METHOD Three-dimensional manual tracings of the head and body of the caudate nucleus and of the cerebrum were acquired from 26 medication-naïve boys with a diagnosis of ADHD (ages 5.9-10.8 years), and 24 age-matched normal controls. RESULTS Boys with ADHD had smaller total caudate volumes relative to controls, F(1,48)=4.29, p=0.04. Adjustment of caudate volumes with respect to age demonstrated that this group difference was driven solely by participants in the 5.9-7.3 year range, F(1, 46)=5.64, p=0.022, with an effect size of d=0.69. No Group effect was found in older participants, F(1, 46)=0.82, p=0.37. CONCLUSIONS These novel findings suggest a different pattern of caudate volume abnormalities across narrow age clusters prior to puberty in boys with ADHD. Anatomical differences in brain structures related to ADHD in prepubertal children should be evaluated with respect to the changing developmental trajectory of brain regions within this period of rapid brain growth.

Cortical Thickness in Young Treatment-Naive Children With ADHD.

Objective: This study aimed to investigate the cortical thickness in areas of the brain that are hypothesized to be involved in response inhibition and error-monitoring behaviors. The authors hypothesized that children with ADHD would have a thinner prefrontal cortex (PFC) and anterior cingulate cortex (ACC) than healthy children. Method: In all, 25 ADHD and 25 healthy control male children (5-12 years) underwent magnetic resonance imaging. Results: The authors found thinner right superior frontal gyrus in ADHD patients compared with controls (t = 2.01, df = 45, p = .049). The older children with ADHD drove this effect when participants were further subdivided into a younger and older age group (older participants: p = .004; younger participants: p = ns). Conclusion: These findings have implications for the developmental trajectory of the frontal lobe in ADHD.

Prefrontal glutamate levels differentiate early phase schizophrenia and methamphetamine addiction: A 1H MRS study at 3 Tesla

Acute symptoms of methamphetamine-induced psychosis are similar to those of primary schizophrenia. Understanding similarities or differences in the biological substrate of these psychoses could lead to early differentiation of these two clinical conditions resulting in more efficient treatment strategies. Proton magnetic resonance spectroscopy was acquired from the medial prefrontal cortex in 29 unmedicated patients with first episode of psychosis (FEP), 29 abstinent methamphetamine-addicted people (METH) and 45 healthy controls (HCs) (age range 17.3 to 29.9years old). The METH group displayed robust reductions in concentration levels of glutamate (Glu) relative to FEP (Cohens d=1.20) and HC (d=0.87). The METH group also displayed reduced levels of N-acetylaspartate (NAA) relative to FEP (d=0.53) and HC (d=0.76). The HC group displayed a positive association between levels of Glu and NAA, r(45)=0.52, p<0.001, while the two clinical groups failed to show this normal association. This suggests that the cellular metabolism is altered in both conditions. These data support the assumption that cellular abnormalities differ between primary schizophrenia and methamphetamine addiction despite the overlap in clinical presentation.

Intensive Short-Term Dynamic Psychotherapy Associated with Decreases in Electroconvulsive Therapy on Adult Acute Care Inpatient Ward

Acute care psychiatric inpatient admissions are frequently precipitated by psychosocial stress including interruptions in key relationships due to a move, separation or other transition. The emotions triggered by these events often induce depression, anxiety, psychotic phenomena and acting-out behavior. Electroconvulsive therapy (ECT) may be an effective tertiary treatment for select patients who fail to respond to first- and second-line guideline-driven treatment options for severe depression [1] . We implemented a form of brief psychotherapy, intensive short-term dynamic psychotherapy (ISTDP), in an acute care psychiatric inpatient service in Halifax, N.S., a city of 400,000 people. At the same time, a new treatment protocol for ECT, the ultra-brief impulse protocol, was implemented to try to reduce ECT side effects on memory loss [2] . The net result of this has previously been shown to be an increase in the number of required ECT procedures per treated case [3] . ISTDP is a brief method that assesses and augments the capacity to identify and feel the very complex emotions triggered in current stressors. The treatment can be effective with high anxiety, severe depression and paranoia through the use of combinations of supportive interventions, emotional focusing, challenge to defenses and cognitive recapitulation, all of which are tailored to patient capacities [4] . Based on a recently published meta-analysis, ISTDP has some empirical support for a wide range of patients including those with depression, anxiety, personality disorders and bipolar disorder who are frequently admitted to psychiatry wards [4] . We also found, in a 10-year follow-up study of 890 cases, a significant reduction in hospital use and costs after a brief course of this treatment (a mean of 7.3 sessions/patient) [5] . During the years 1998–2009, this method was used on an ad hoc basis to augment standard care for psychiatric inpatients with these conditions. We reported on the method, including case descriptions, illustrating how it appeared effective in preventing the need for ECT and helpful to some of those who failed ECT [6] . Based on these data, a part-time position for an inpatient psychologist trained in ISTDP was funded, starting in October 2010. To augment the understanding of the approach and facilitate the referral process the therapist joined in weekly team rounds to dis

Multimodal neuroimaging of frontal white matter microstructure in early phase schizophrenia: the impact of early adolescent cannabis use

BackgroundA disturbance in connectivity between different brain regions, rather than abnormalities within the separate regions themselves, could be responsible for the clinical symptoms and cognitive dysfunctions observed in schizophrenia. White matter, which comprises axons and their myelin sheaths, provides the physical foundation for functional connectivity in the brain. Myelin sheaths are located around the axons and provide insulation through the lipid membranes of oligodendrocytes. Empirical data suggests oligodendroglial dysfunction in schizophrenia, based on findings of abnormal myelin maintenance and repair in regions of deep white matter. The aim of this in vivo neuroimaging project is to assess the impact of early adolescent onset of regular cannabis use on brain white matter tissue integrity, and to differentiate this impact from the white matter abnormalities associated with schizophrenia. The ultimate goal is to determine the liability of early adolescent use of cannabis on brain white matter, in a vulnerable brain.Methods/DesignYoung adults with schizophrenia at the early stage of the illness (less than 5 years since diagnosis) will be the focus of this project. Four magnetic resonance imaging measurements will be used to assess different cellular aspects of white matter: a) diffusion tensor imaging, b) localized proton magnetic resonance spectroscopy with a focus on the neurochemical N-acetylaspartate, c) the transverse relaxation time constants of regional tissue water, d) and of N-acetylaspartate. These four neuroimaging indices will be assessed within the same brain region of interest, that is, a large white matter fibre bundle located in the frontal region, the left superior longitudinal fasciculus.DiscussionWe will expand our knowledge regarding current theoretical models of schizophrenia with a more comprehensive multimodal neuroimaging approach to studying the underlying cellular abnormalities of white matter, while taking into consideration the important confounding variable of early adolescent onset of regular cannabis use.