In a study that may significantly advance the understanding of how cognitive-behavioral therapy affects the brain, researchers have shown that significant changes in activity in certain regions of the brain can be produced with as little as four weeks of daily therapy in patients with obsessive-compulsive disorder (OCD). The discovery could have important clinical implications, according to principal investigator Sanjaya Saxena, M.D., Director of the Obsessive-Compulsive Disorders Program at the University of California, San Diego (UCSD) School of Medicine, whose findings are published on line this week in the journal Molecular Psychiatry.

“The study is exciting because it tells us more about how cognitive-behavioral therapy works for OCD and shows that both robust clinical improvements and changes in brain activity occur after only four weeks of intensive treatment," said Saxena.

OCD is an anxiety disorder in which individuals have unreasonable fears or worries that they try to manage through ritualized compulsive behaviors to reduce the anxiety. For example, a patient may experience the urgent need to engage in certain rituals, such as hand washing or repeatedly checking that the oven is off or the front door is locked.

Past studies using functional brain imaging studies of patients with OCD have demonstrated that elevated activity along the frontal-subcortical circuits of the brain decreases in response to treatment with serotonin reuptake inhibitor (SRI) medications or cognitive-behavioral therapy. However, clinical improvement of OCD symptoms was expected to require up to 12 weeks of behavioral therapy or medication treatment, the standard treatments for OCD. Only a handful of studies have looked at how therapy affects brain function, and all previous studies had examined changes over several months of treatment.

Saxena and colleagues at the David Geffen School of Medicine at UCLA made two novel discoveries in their study of 10 OCD patients and 12 control subjects. “First of all, we discovered significant changes in brain activity solely as the result of four weeks of intensive cognitive-behavioral therapy,” said Saxena. “Secondly, these changes were different than those seen in past studies after a standard 12-week therapeutic approach using SRI medications or weekly behavioral therapy.” The researchers obtained positron emission tomography (PET) scans of the ten OCD patients both before and after they received four weeks of a therapy known as “exposure and response prevention,” which gradually desensitizes patients to things that provoke obsessional fears or worries. “This is the primary kind of therapy used for OCD. It teaches patients to pay attention to their internal experiences and tolerate scary thoughts without having to act on them,” said Saxena. “They learn that nothing terrible happens if they refrain from their usual compulsive behaviors.”

The normal control subjects received no treatment and were scanned twice, several weeks apart, and metabolic changes in the brain were compared between the two groups. After four weeks of therapy and without any changes in medication, the OCD patients showed significant improvements in OCD symptoms, depression, anxiety and overall functioning. The PET scans of OCD patients demonstrated significant decreases in glucose metabolism – a measure of brain cell activity – in the right and left thalamus after treatment. These are areas of the brain involved in OCD and where changes have been seen in numerous past studies after longer-term treatment.

However, the PET scans in this study also showed a significant increase in activity in an area of the brain called the right dorsal anterior cingulate cortex, a region involved in reappraisal and suppression of negative emotions. Increasing activity in this region corresponded to the OCD patients’ improvement in clinical symptoms after the four-week course of intensive therapy. Activity in this area had previously been found to increase after cognitive-behavioral therapy for major depression. Therefore, the researchers theorize that response to cognitive-behavioral therapy across a variety of disorders may require activation of the dorsal anterior cingulate cortex, according to Saxena.

Turner, E.H., Matthews, A.M., Linardatos, E., Tell, R.A., & Rosenthal, R. (2008). Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy. New England Journal of Medicine, 358(3). 252-260.

ABSTRACT
Background: Evidence-based medicine is valuable to the extent that the evidence base is complete and unbiased. Selective publication of clinical trials — and the outcomes within those trials — can lead to unrealistic estimates of drug effectiveness and alter the apparent risk–benefit ratio.

Methods: We obtained reviews from the Food and Drug Administration (FDA) for studies of 12 antidepressant agents involving 12,564 patients. We conducted a systematic literature search to identify matching publications. For trials that were reported in the literature, we compared the published outcomes with the FDA outcomes. We also compared the effect size derived from the published reports with the effect size derived from the entire FDA data set.

Results: Among 74 FDA-registered studies, 31%, accounting for 3449 study participants, were not published. Whether and how the studies were published were associated with the study outcome. A total of 37 studies viewed by the FDA as having positive results were published; 1 study viewed as positive was not published. Studies viewed by the FDA as having negative or questionable results were, with 3 exceptions, either not published (22 studies) or published in a way that, in our opinion, conveyed a positive outcome (11 studies). According to the published literature, it appeared that 94% of the trials conducted were positive. By contrast, the FDA analysis showed that 51% were positive. Separate meta-analyses of the FDA and journal data sets showed that the increase in effect size ranged from 11 to 69% for individual drugs and was 32% overall.

Conclusions: We cannot determine whether the bias observed resulted from a failure to submit manuscripts on the part of authors and sponsors, from decisions by journal editors and reviewers not to publish, or both. Selective reporting of clinical trial results may have adverse consequences for researchers, study participants, health care professionals, and patients.

NEJM: 17 January 2008

"No Clowning for Hospitalized Kids"
60-Second Science from Scientific American podcasts
January 17, 2008

Researchers spoke to 255 kids between the ages of 4 and 16.  And none of them liked clowns. 

According to the magazine Nursing Standard, one researcher said, “We found that clowns are universally disliked by children. Some found them frightening and unknowable.”

Find topical links to information resources that may be of interest to victims of crime. For additional information on available services in your area, visit OVC's Directory of Crime Victim Services.

BIDEN, COLLINS Resolution Designates January as National Stalking Awareness Month

Washington, DC – U.S. Senators Joseph R. Biden, Jr. (D-DE) and Susan Collins (RME) introduced a resolution designating January as National Stalking Awareness Month. This is the fifth consecutive year the Senate has considered the resolution, which applauds the efforts of policymakers, law enforcement officers, victim service providers, and other groups that currently promote stalking awareness.

“Stalking is not a one-time occurrence; this is a crime that leaves its victim fearful 24 hours a day, seven days a week. No place – not even home – is safe if a stalker knows where the victim lives. Victims spend their days and nights looking over their shoulder, often changing jobs, relocating their homes, and even changing their appearance to escape the stalker,” said Sen. Biden, author of the landmark Violence Against Women Act. In many instances, victims usually know their stalkers and 81 percent of women victims are also physically assaulted by their stalker. “January is National Stalking Awareness Month – the perfect opportunity for parents, lawmakers and community leaders to carefully review state and local laws on stalking and insist that laws keep pace with technology and protect victims.”

“I am pleased to join my colleague, Senator Biden, in introducing a Resolution marking January as National Stalking Awareness Month,” said Sen. Collins. “In my home state of Maine, domestic violence is a widespread problem. Many experts have concluded that there is a strong connection between stalking and violence toward women. Efforts, such as National Stalking Awareness Month, help raise awareness about this serious and potentially deadly crime.”

According to the National Center for Victims of Crime and the Stalking Resource Center, approximately 1 million women and 400,000 men are victims of stalking in this country annually. 1 in 12 women and 1 in 45 men will be stalked at some point in their lives, as well as close to 13 percent of female college students. Moreover, today’s technology has made stalking much easier, as stalkers can design websites to encourage others to monitor or harm their victim, install spyware on their victim’s computer or plant global positioning systems (GPS) in their victim’s car to track their victim’s travels. Other technologies, including social networking websites, such as Facebook and MySpace, cell phones with surveillance devices meant for parents monitoring their children, and running shoes implanted with GPS devices, may provide additional opportunities for stalkers to harm their victims. While all fifty states have laws against stalking, only one third of states have included language relating to stalking via electronic means.

“Stalking is a serious and potentially lethal crime,” said Mary Lou Leary, executive director of the National Center for Victims of Crime. “We thank Senators Biden and Collins for introducing this National Stalking Awareness Month resolution, which will raise awareness about the impact of stalking on more than 1.4 million Americans each year.”

“We can – and we must – do more to ensure that stalking victims are not forced to live in constant fear and that stalkers are brought to justice,” added Sen. Biden. For victim assistance, call the National Crime Victim Helpline at 1-800-FYICALL. Visit www.ncvc.org/src for a map of activities planned around the country for National Stalking Awareness Month and for more information.

QuickStats: Life Expectancy at Birth, by Race* and Sex --- United States, 1970--2005
Center for Disease Control Morbidity and Mortality Weekly Report (4 January || 56(51);1347)


* Races include non-Hispanics and Hispanics.

Longer commutes due to fewer lane changes, slower speeds

Motorists who talk on cell phones drive slower on the freeway, pass sluggish vehicles less often and take longer to complete their trips, according to a University of Utah study that suggests drivers on cell phones congest traffic.

“At the end of the day, the average person’s commute is longer because of that person who is on the cell phone right in front of them,” says University of Utah psychology Professor Dave Strayer, leader of the research team. “That SOB on the cell phone is slowing you down and making you late.”

“If you talk on the phone while you’re driving, it’s going to take you longer to get from point A to point B, and it’s going to slow down everybody else on the road,” says Joel Cooper, a doctoral student in psychology.

Cooper is scheduled to present the study in Washington on Wednesday, Jan. 16 during the Transportation Research Board’s annual meeting. The board is part of the National Academies, parent organization of the National Academy of Sciences, National Academy of Engineering and Institute of Medicine.

Cooper and Strayer conducted the study with Ivana Vladisavljevic, a doctoral student in civil and environmental engineering, and Peter Martin, an associate professor of civil and environmental engineering and director of the University of Utah Traffic Lab. Martin says that, combined with Strayer’s previous research, the new study shows “cell phones not only make driving dangerous, they cause delay too.” [read more]