This small study suggests that olanzapine is generally well tolerated by, and may provide more benefit than placebo for out-patients with AN. Further study is indicated to determine whether olanzapine may affect psychological symptoms in addition to BMI.
IMPORTANCE Dimensional definitions of transdiagnostic mental health problems have been suggested as an alternative to categorical diagnoses, having the advantage of capturing heterogeneity within diagnostic categories and similarity across them and bridging more naturally psychological and neural substrates. OBJECTIVE To examine whether a self-reported compulsivity dimension has a stronger association with goal-directed and related higher-order cognitive deficits compared with a diagnosis of obsessive-compulsive disorder (OCD). DESIGN, SETTING, AND PARTICIPANTSIn this cross-sectional study, patients with OCD and/or generalized anxiety disorder (GAD) from across the United States completed a telephone-based diagnostic interview by a trained rater, internet-based cognitive testing, and self-reported clinical assessments from October 8, 2015, to October 1, 2017. Follow-up data were collected to test for replicability. MAIN OUTCOMES AND MEASURESPerformance was measured on a test of goal-directed planning and cognitive flexibility (Wisconsin Card Sorting Test [WCST]) and a test of abstract reasoning. Clinical variables included DSM-5 diagnosis of OCD and GAD and 3 psychiatric symptom dimensions (general distress, compulsivity, and obsessionality) derived from a factor analysis. RESULTS Of 285 individuals in the analysis (mean [SD] age, 32 [12] years; age range, 18-77 years; 219 [76.8%] female), 111 had OCD; 82, GAD; and 92, OCD and GAD. A diagnosis of OCD was not associated with goal-directed performance compared with GAD at baseline (β [SE], −0.02 [0.02]; P = .18). In contrast, a compulsivity dimension was negatively associated with goal-directed performance (β [SE], −0.05 [0.02]; P = .003). Results for abstract reasoning task and WCST mirrored this pattern; the compulsivity dimension was associated with abstract reasoning (β [SE], 2.99 [0.63]; P < .001) and several indicators of WCST performance (eg, categories completed: β [SE], −0.57 [0.09]; P < .001), whereas OCD diagnosis was not (abstract reasoning: β [SE], 0.39 [0.66]; P = .56; categories completed: β [SE], −0.09 [0.10]; P = .38). Other symptom dimensions relevant to OCD, obsessionality, and general distress had no reliable association with goal-directed performance, WCST, or abstract reasoning. Obsessionality had a positive association with requiring more trials to reach the first category on the WCST at baseline (β [SE], 2.92 [1.39]; P = .04), and general distress was associated with impaired goal-directed performance at baseline (β [SE],−0.04 [0.02]; P = .01). However, unlike the key results of this study, neither survived correction for multiple comparisons or was replicated at follow-up testing.CONCLUSIONS AND RELEVANCE Deficits in goal-directed planning in OCD may be more strongly associated with a compulsivity dimension than with OCD diagnosis. This result may have implications for research assessing the association between brain mechanisms and clinical manifestations and for understanding the structure of mental illness.
Objective-To use a Progressive Ratio (PR) computerized "work" paradigm to measure course and correlates of exercise motivation in inpatients with Anorexia Nervosa (AN).Method-Sixteen inpatients with AN participated in a PR task assessing the relative reinforcing effect of 2 different increments of cash versus the opportunity to exercise for up to 30 minutes, twice; at low weight, and, for n=10 participants, after weight restoration.Results-There was a trend toward a higher work for exercise with $2 versus $5 increments of cash as the alternative reinforcer. Exercise breakpoint did not differ between low and normalweight states. Exercise breakpoint at each time point was correlated with pre-hospitalization exercise "commitment" (Commitment to Exercise Scale, r=0.613, p=0.012 at T1; r=0.634, p=0.049 at T2).Discussion-Patients with AN will work at a PR task for access to even a small amount of exercise. Exercise motivation during hospitalization is correlated with pre-hospital exercise commitment, and does not appear to change consistently with weight restoration.
Tracy struggles with het emotions, visibly frustrated and angered by the contentious interactions with her mother and her best friend. She lives with het single but watm and attentive mothet and btothet in a working-class California neighborhood. At 13, Ttacy is the epitome of a junior high schoolerworried about fitting in, growing up, and reconciling a somewhat turbulent past with the promise of future independence. One night, after a particularly volatile exchange with her mother followed by a disappointing experience with het best friend, Tracy's agitation is palpable. At the pinnacle of her distress, Tracy makes her way to the bathroom and reaches for a pait of small scissors stored in the vanity. Although a typical part of bathroom paraphernalia, the scissors serve a particulat and unusual function for Tracy. Sinking to the floot, she slides the sharp edge across her wrist-lightly enough to avoid setious injury, but deep enough to cause blood to well up as it slowly passes ovet the delicate skin. On her wrist lie the telltale signs of othet, similar moments. Aftet one long cut, she lets the blades fall dtunkenly from het hand as she covers her wounds with her shirtsleeve-already stained with dried blood. As Tracy sits crumpled on the floor, the camera zooms out and the scene assumes a slightly fuzzy focus. Sirens wail low and distant in the 139
Social anxiety disorder (SAD) is one of the most prevalent psychiatric disorders in the United States. Although evidenced-based behavioral treatments are available, less than 20% of those with SAD receive treatment. Internet-based interventions can address barriers to treatment access, and guided Internet-based treatments have been demonstrated to be effective for SAD. However, the optimal role (if any) of the therapist in such programs remains unclear. We examined the acceptability and efficacy of a novel Internet-based cognitive-behavior therapy for SAD that utilizes traditional behavioral interventions (e.g., exposure) within the context of a model emphasizing mindfulness and psychological acceptance. Forty-two participants were randomized to an eight-module self-help intervention with ( n = 20) or without ( n = 22) adjunctive therapist support; the therapist support was delivered through 10 to 15 min of weekly videoconferencing and daily text messages. Both groups experienced a significant reduction in SAD symptoms and improvements in functioning and quality of life, with no significant differences between groups in both completer-only and intent-to-treat analyses. However, the therapist support group evidenced lower attrition than the minimal support group (20% vs. 50%). Implications for dissemination and future directions are discussed.
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