Measuring maladaptive avoidance: from animal models to clinical anxiety

Avoiding stimuli that predict danger is required for survival. However, avoidance can become maladaptive in individuals who overestimate threat and thus avoid safe situations as well as dangerous ones. Excessive avoidance is a core feature of anxiety disorders, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). This avoidance prevents patients from confronting maladaptive threat beliefs, thereby maintaining disordered anxiety. Avoidance is associated with high levels of psychosocial impairment yet is poorly understood at a mechanistic level. Many objective laboratory assessments of avoidance measure adaptive avoidance, in which an individual learns to successfully avoid a truly noxious stimulus. However, anxiety disorders are characterized by maladaptive avoidance, for which there are fewer objective laboratory measures. We posit that maladaptive avoidance behavior depends on a combination of three altered neurobehavioral processes: (1) threat appraisal, (2) habitual avoidance, and (3) trait avoidance tendency. This heterogeneity in underlying processes presents challenges to the objective measurement of maladaptive avoidance behavior. Here we first review existing paradigms for measuring avoidance behavior and its underlying neural mechanisms in both human and animal models, and identify how existing paradigms relate to these neurobehavioral processes. We then propose a new framework to improve the translational understanding of maladaptive avoidance behavior by adapting paradigms to better differentiate underlying processes and mechanisms and applying these paradigms in clinical populations across diagnoses with the goal of developing novel interventions to engage specific identified neurobehavioral targets.

SOCIAL ANXIETY, DEPRESSION, COPING SELF-EFFICACY, AND COPING STRATEGIES AMONG COLLEGE STUDENTS

The transition to college and its associated social challenges could trigger social anxiety and depression among young college students. There is a paucity of literature relating coping self-efficacy, coping strategies, social anxiety and depression. The current study aims to fill this gap by finding the contributions of gender, coping self-efficacy (CSE), and coping strategies onto the levels of social anxiety and depression among college students. It also aims to find race-ethnicity differences, considering students’ level of social anxiety and depression. One hundred and fifty-eight students were recruited from the undergraduate psychology subject pool at a northeastern university. The Liebowitz Social Anxiety Scale, Diagnostic Inventory for Depression, Coping Self-Efficacy Scale and Brief COPE were used to measure the study variables. A one-way ANOVA and simultaneous multiple linear regression analyses were conducted to examine data. There were no significant race-ethnicity differences in social anxiety, depressive symptom severity, psychosocial impairment, and quality of life. However, gender and self-blame significantly predicted social anxiety; substance use, behavioral disengagement, and self-blame significantly predicted depressive symptom severity; and social support CSE significantly predicted psychosocial impairment. Gender, dysfunctional coping strategies and social-support CSE were significantly associated with social anxiety and depression among college students. The results have important implications for treatment intervention and outreach by college counseling personnel.

Quality of life and mental health of children with rare congenital surgical diseases and their parents during the COVID-19 pandemic

Background COVID-19 has affected our society at large, particularly vulnerable groups, such as children suffering from rare diseases and their parents. However, the psychosocial influences of COVID-19 on these have yet to be investigated. As such, the study’s goal was to evaluate the health-related quality of life (HRQoL), quality of life (QoL), and mental health of children with rare congenital surgical diseases and their parents during the COVID-19 pandemic and lockdown measures. Methods A survey of n = 210 parents of children with rare congenital surgical diseases and a control group of n = 88 parents of children without rare diseases was conducted cross-sectionally between April 2020 to April 2021. Data on HRQoL, QoL, and mental health was collected using standardized psychometric questionnaires for children and parents presenting to the pediatric surgery department at a university hospital. Results Mothers of children with rare pediatric surgical diseases showed significantly lower QoL and significantly higher impairment in mental health than a control group and norm data. For fathers, this was solely the case for their QoL. Children’s parent-reported HRQoL and mental health were partially impaired. Social and disease-specific risk factors of the respective outcomes in affected families were identified through regression analysis models. Conclusion Parents of children with rare diseases report severe psychosocial impairment regarding themselves and their children during the COVID-19 pandemic. Therefore, affected families should receive attention and supportive care in the form of a family-center approach to alleviate the additional burden of the COVID-19 pandemic.

Delivering CBT-E In an Online Group Format: A Pilot Study in a Child and Adolescent Eating Disorder Service

Background: The increased prevalence of eating disorders during the COVID-19 pandemic has placed services for children and adolescents under immense pressure. The high number of people at medical risk has led to longer waiting lists for psychological support for those who are physically stable. A pilot study was conducted to evaluate the feasibility and effectiveness of providing group enhanced cognitive behavioral therapy for eating disorders (CBT-E), in a virtual setting, as a way of increasing the provision of evidence-based treatment during the pandemic.Method: Clinicians in a child and adolescent eating disorder service were invited to refer patients to take part in a six-session course of therapy comprising the CBT-E Stage Three Body Image module. Primary outcomes were acceptance rates, completion rates, qualitative feedback and quantitative data from routine measures of eating disorder psychopathology and psychosocial impairment.Results: From 22 eligible referrals, 12 participants accepted and enrolled in therapy. Eight completed all six sessions. Qualitative feedback was positive. Both the content and group nature of the intervention were described as helpful. There was an improvement in all scores on the psychometric tests. Conclusions: This pilot study demonstrated that online group CBT-E was a feasible method of providing psychological therapy within the service. A larger trial is recommended to robustly test the effectiveness of the intervention compared to one-to-one in-person CBT-E, and to test whether other modules of the CBT-E protocol can be similarly delivered in this population.Trial registration: This study was pre-registered and approved as a clinical service evaluation by the Oxford Health NHS Foundation Trust, United Kingdom

Measuring maladaptive avoidance: from animal models to clinical anxiety

Avoiding stimuli that predict danger is required for survival. However, avoidance can become maladaptive in individuals who overestimate threat and thus avoid safe situations as well as dangerous ones. Excessive avoidance is a core feature of anxiety disorders, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). This avoidance prevents patients from confronting maladaptive threat beliefs, thereby maintaining disordered anxiety. Avoidance is associated with high levels of psychosocial impairment yet is poorly understood at a mechanistic level. Many objective, laboratory assessments of avoidance measure adaptive avoidance, in which an individual learns to successfully avoid a truly noxious stimulus. However, anxiety disorders are characterized by maladaptive avoidance, for which there are fewer objective laboratory measures. We posit that maladaptive avoidance behavior depends on a combination of three altered neurobehavioral processes: (1) threat appraisal, (2) trait avoidance tendency, and (3) habitual avoidance. This heterogeneity in underlying processes presents challenges to the objective measurement of maladaptive avoidance behavior. Here we first review existing paradigms for measuring avoidance behavior and its underlying neural mechanisms in both human and animal models, and identify how existing paradigms relate to these neurobehavioral processes. We then propose a new framework to improve the translational understanding of maladaptive avoidance behavior by adapting paradigms to better differentiate underlying processes and mechanisms and applying these paradigms in clinical populations across diagnoses with the goal of developing novel interventions to engage specific identified neurobehavioral targets.

Psychosocial impairment in children with Celiac disease.

Objective: To determine the frequency of psychosocial impairment in patients with celiac disease. Study Design: Descriptive Cross Sectional study. Setting: Children Hospital Complex and Institute of Child Health, (CHICH) Multan. Period: August 2019 to August 2020. Material & Methods: A total number of 177 patients having age 4-16 years with diagnosis of CD were included in this study. In children with CD depressive illness were assessed by using Pediatric symptoms checklist (PSC) form and this PSC form was filled by asking questions from parents then filling of form by doctor. Outcome variable was calculated on the basis of Pediatric symptoms checklist (PSC), whether patient has psychosocial illness or not. Results: Mean age of patients was 8.91±3.50 years. Mean duration of celiac disease of patients was 4.27±2.00 months. There were 135 (76.27%) female patients and 42 (23.73%) male patients. Mean serum anti-tissue transglutaminase IgA (tTG-IgA) level of patients was 122.73±24.31 µg/ml. The socioeconomic status of 115 (64.97%) patients was poor, 31 (17.51%) was middle, 18 (10.17%) patient was upper middle and 13 (7.34%) patients was high. Psychosocial illness was present in 35 (19.77%) patients. Conclusion: Psychosocial illness was diagnosed in 19.77% children having CD. So the children with celiac disease should be monitored for symptoms of anxiety and depression and a thorough counselling of the children to reduce the risk of psychosocial illness.

A Observational Study on Hypopigmented \ Depigmented Macules in Geriatric Population Attending Dermatology OPD in a Tertiary Care Centre

This article lays out the common hypopigmented \depigmented lesions in geriatric population encountered in dermatology OPD in a tertiary care centre in India. Hypopigmented/depigmented lesions is commonly encountered in a dermatology OPD on a day to day basis. This study is an observational study carried out on 100 patients in dermatology OPD in a tertiary care centre who satisfied the inclusion criteria of age more than 60 years with hypopigmented or depigmented lesions. Hypopigmented/depigmented lesions have a great impact on patients aesthetic appearance leading to psychosocial impairment. A further research with larger sample size and longer study duration can help us understand hypomelanosis in geriatric population better.

Cognitive dimensions of major depressive disorder

Major depressive disorder is characterized by impaired affect, cognitive dysfunction, and significant psychosocial impairment that persists from weeks to years. Cognitive symptoms are pervasive, affecting functioning in several domains, including reduced executive functioning, attention, memory, learning, psychomotor speed, and verbal processing. Recent evidence suggests that cognitive dysfunction persists following symptomatic remission, highlighting the need to treat cognition separately from mood symptoms. Residual cognitive deficits may contribute to ongoing occupational and social dysfunction and promote suicide ideation. In addition, retention of cognitive impairment may interact with existing emotional and social vulnerability, increasing the risk of recurrent depressive episodes. The chapter characterizes the domains of emotional, nonemotional, and social cognitive function in major depressive disorder. It examines the domains and descriptors of nonemotional cognitive function. It evaluates the important relationship between cognitive deficits and psychosocial function, as well as the clinical interactions between ‘cold’ and ‘hot’ cognitive function. It extends our understanding of the social cognitive function and its implications for social performance and impact on emotional and empathic performance.

Laser Therapy for the Treatment of Morphea: A Systematic Review of Literature

Morphea, also known as localized scleroderma (LoS), comprises a set of autoimmune sclerotic skin diseases. It is characterized by inflammation and limited thickening and induration of the skin; however, in some cases, deeper tissues might also be involved. Although morphea is not considered a life-threatening disease, the apparent cosmetic disfigurement, functional or psychosocial impairment affects multiple fields of patients’ quality of life. Therapy for LoS is often unsatisfactory with numerous treatments that have only limited effectiveness or considerable side effects. Due to the advances in the application of lasers and their possible beneficial effects, the aim of this study is to review the reported usage of laser in morphea. We present a systematic review of available literature, performed with MEDLINE, Cinahl, Central, Scopus, Web of Science, and Google Scholar databases. We identified a total of twenty relevant studies (MEDLINE n = 10, Cinahl n = 1, Central n = 0, Scopus n = 2, Web of Science n = 5, Google Scholar n = 2) using laser therapy for LoS. Eight studies were focused on the use of PDL, six on fractional lasers (CO2 and Er:YAG), four on excimer, and two on either alexandrite or Nd:YAG.