[Natural history of HIV infection].
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AIDS-Related Opportunistic Infections↗
Biomedical subjects
Daniel David
Publications and source records attributed to Daniel David.
Cognitions in cognitive-behavioral psychotherapies; toward an integrative model.
There seems to be a lack of a coherent and integrative theory and theoretically informed manuals in cognitive behavioral therapies that could negatively impact both the program of CBT as a platform for psychotherapy integration, as well as its efficacy and effectiveness. Although CBT is the golden psychological treatment for various disorders, overall, about 30-40% of the patients are still non-responsive to these interventions and various schools debate their status as promoters of the best theoretical view. The objective of the present paper is to use cognitive psychology/science as a tool to clarify several theoretical confusions in CBT, with impact on a coherent science and practice of CBT. As a general conclusion, we believe that CBT has reached preeminence in the clinical field betting on cold cognitions. Despite obvious advantages and accomplishments, this approach seems to loose its heuristic value. We believe that the next phase of CBT development lies in the construct of hot cognitions (which would increase its effectiveness) and in cognitive psychology (which would contribute to a coherent science of CBT beyond various schools). These developments could offer CBT the chance to be a platform for the integration of psychotherapy.
Autobiographies as Topic↗
High prevalence of thrombophilia among young patients with myocardial infarction and few conventional risk factors.
BACKGROUND: Thrombophilia refers to series of acquired and inherited conditions that confer a tendency to thrombus formation. The exact relationship between thrombophilia and MI is not well established. OBJECTIVES: To determine the prevalence of thrombophilia in young patients with their first MI and few conventional risk factors. METHODS: We evaluated the baseline characteristics and the thrombophilia profile, including anti-cardiolipin antibodies, activated protein C resistance (APCR) with the factor V Leiden mutation, prothrombin G20210A mutation, protein C, protein S, and antithrombin-III levels, among 85 consecutive patients (<50 year old) who were admitted to CCU with their first MI. Patients were divided into two groups: group A-patients with < or =1 risk factor and group B-patients with > or =2 risk factors. RESULTS: 92% were male and 55% with anterior wall MI. Overall, the risk factor profile was: smoking in 60%, hyperlipidemia in 42%, positive family history in 29%, hypertension in 18%, diabetes mellitus in 13%, and obesity in 8%. Forty-seven percent of patients had < or =1 risk factor (n=40, group A) and 53% had > or =2 risk factors (n=45, group B). The prevalence of the prothrombin mutation was 15% in group A compared to 7% in group B (p=0.12). APCR secondary to a heterozygous genotype of factor V Leiden mutation was found in 20% in group A compared to 2% in group B (p<0.01). Anti-cardiolipin antibodies were found in 16% in group A compared to 22% in group B (p=ns). Finally, we have found that the likelihood of identifying at least one thrombophilia marker was 50% in group A compared to 29% in group B (p=0.046). CONCLUSIONS: The likelihood to detect at least one thrombophilia marker in young patients with MI and few conventional risk factors is significantly high. Thrombophilia may contribute to the development of MI in this specific group of young patients.
Adult↗
An empirical investigation of Albert Ellis's binary model of distress.
In the current literature, distress is typically described according to a unitary model: High levels of distress are conceptualized as a high level of negative affect while low levels of distress are typically conceptualized as a low level of negative affect. On the other hand, Albert Ellis (1994) and some of his rational-emotive and cognitive-behavioral professional colleagues have more recently described distress as a binary construct composed of two different components: functional negative feelings (e.g., sad) and dysfunctional negative feelings (e.g., worthless). In two studies using 55 U.S. breast-cancer patients and 45 Romanian breast-cancer patients, respectively, we compared hypotheses derived from unitary and binary models of distress. The results revealed that in a stressful situation (i.e., upcoming breast surgery) high levels of irrational beliefs were associated with a high level of both functional and dysfunctional negative feelings while low levels of irrational beliefs were associated with a low level of dysfunctional negative feelings and a high level of functional negative feelings. Thus, that support for the binary model of distress found in both U.S. and Romanian samples suggests both the robustness and the generalizability of the results. Theoretical and practical implications are discussed.
Adult↗
Beneficial effects of intraventricularly administered BMP-7 following a striatal 6-hydroxydopamine lesion.
The present study was undertaken to investigate the effects of bone morphogenetic protein-7 (BMP-7), also named osteogenic protein-1 (OP-1), on the progression of a striatal 6-hydroxydopamine (6-OHDA) lesion. BMP-7, a member of the transforming growth factor-beta (TGF-beta) superfamily of proteins, has been shown to have protective effects in other animal models of neuronal damage. In this study, male Fischer 344 rats received striatal 6-OHDA lesions followed 1 week later by an intraventricular dose of BMP-7. No significant effect of BMP-7 treatment on spontaneous locomotor activity was observed, however BMP-7 significantly increased the density of tyrosine hydroxylase (TH) immunoreactivity (TH-ir) in the substantia nigra (SN) pars compacta, in the lesioned hemisphere [31.7+/-5.2 (optical density (O.D.) arbitrary units) control vs. 50.2+/-4.3 O.D. BMP-7-treated; p<0.05]. Interestingly, BMP-7 significantly increased TH-ir in the SN of the non-lesioned hemisphere (pars reticulata: 14.8+/-1.19 O.D. control vs. 36+/-2.6 O.D. BMP-7-treated, p<0.05; pars compacta: 29.0+/-4.9 O.D. control vs. 64.4+/-6.9 O.D. BMP-7-treated, p<0.001). A significant increase in DA concentration in the contralateral, non-lesioned hemisphere was also noted (113.2 ng/g control vs. 198.2 ng/g BMP-7-treated, p<0.01). In contrast to other intraventricularly administered neurotrophic factors, BMP-7 was not associated with an increase in the sensitivity to pain. These results suggest that BMP-7 is able to act as a dopaminotrophic agent without unwanted side effects and as such may be a useful pharmacological tool in the treatment of Parkinson's disease in humans.
Animals↗
Special issue on the cognitive revolution in clinical psychology: Beyond the behavioral approach-Introductory remarks.
Recently, the impact of the cognitive revolution on the clinical field has been challenged by behavioral professionals at both theoretical and practical levels. This article is a brief introduction to a special issue of the Journal of Clinical Psychology and presents the objectives and the structure of this special issue.
Behavior Therapy↗
The information-processing approach to the human mind: Basics and beyond.
Cognitive psychology attempts to understand the nature of the human mind by using the information-processing approach. In this article, the fundamentals of the cognitive approach will be presented. It will be argued that the human mind can be described at three levels-computational, algorithmic-representational, and implementational-and that the cognitive approach has both important theoretical and practical/clinical implications. Finally, it will be suggested that the study of cognitive psychology can provide a foundation for other fields of social science, including the field of clinical psychology.
Cognition↗
Special issue on the cognitive revolution in clinical psychology: beyond the behavioral approach-conclusions: toward an evidence-based psychology and psychotherapy.
Integrating the criticisms of the cognitive psychology approach offered by behavioral oriented professionals, as well as the information offered in this special issue of the Journal of Clinical Psychology, the article presents an overview of the theoretical and practical implications of the cognitive revolution on the clinical field and discusses the unique contribution of this approach beyond the contribution of the behavioral approach.
Behavior Therapy↗
Coronary risk factor management in the framework of a community hospital-based ambulatory exercise training program.
Ischemic heart disease is a chronic illness that causes major mortality and morbidity. Angiographic studies have shown the effectiveness of exercise programs, in combination with aggressive lipid management, in reversing or slowing the progression of atherosclerotic coronary disease. Despite these studies, participation in supervised programs that combine exercise and risk-factor management is limited. The authors measured the ability of a community hospital-based ambulatory cardiac rehabilitation program to recruit patients and to facilitate reduction of risk factors that have been demonstrated to influence progression of disease. Patients were recruited from a single community hospital for an ambulatory exercise training and cardiac risk-factor management program, and clinical and laboratory data was collected periodically. Recruited patients participated in a minimum 3-month period of training and counseling by a multidisciplinary team with follow-up measurements of weight, lipid profile, blood pressure, and exercise capacity. Thirty-two percent of the eligible hospitalized patients were successfully recruited into the program. Dropout rates over the initial 3 months were low (25%). Improvement in low-density lipoprotein cholesterol level (-4.5%), high-density lipoprotein cholesterol level (+7%), body mass index (-2%), systolic blood pressure (-3%), and maximum metabolic equivalents (+25%) were comparable to levels achieved in studies showing angiographic stabilization and/or regression of disease. Implementation of a community hospital-based risk management exercise program is an effective method for improving the long-term management of patients with chronic ischemic heart disease.
Blood Pressure↗
Another person's heart: magical and rational thinking in the psychological adaptation to heart transplantation.
BACKGROUND: The goal of this study was to examine heart transplant recipients' psychological adaptation to another person's heart, with particular emphasis on recipients' attitudes toward graft and donor. METHOD: Thirty-five male heart recipients were examined by: the Symptom Distress Checklist (revised) (SCL-90-R); the Depression Adjective Checklist (DACL); a Post-Traumatic Stress Disorder Questionnaire (PTSD-Q); a Heart Image Questionnaire (HIQ); and a Semi-Structured Interview (SSI), aimed at eliciting attitudes and fantasies regarding the transplanted heart. RESULTS: All instruments indicated high levels of stress even several years after the transplant, but, simultaneously, 73% of recipients felt that acquiring a new heart had had a dramatic influence on their lives with a new appreciation of the preciousness of life and a shift of priorities, toward altruism and spirituality. Sixty percent returned to work after the transplant but some had to adapt to a changed attitude from those around them who regarded them as anything from mystical creatures to vulnerable or still-sick individuals. While all recipients possessed a scientific knowledge of the anatomy and physiological significance of the heart (as revealed in the HIQ), many endorsed fantasies and displayed magical thinking: 46% of the recipients had fantasies about the donor's physical vigor and prowess, 40% expressed some guilt regarding the death of the donor, 34% entertained the possibility of acquiring qualities of the donor via the new heart. When asked to choose a most and least preferred imagined donor, 49% constructed their choices according to prejudices, desires, or fears related to ethnic, racial or sexual traits attributed to the donor. CONCLUSIONS: This study confirms the intuitive idea that heart transplant involves a stressful course of events that produces an amplified sense of the precariousness of existence. Simultaneously, it gives rise to rejoicing at having been granted a new lease on life and a clear sense of new priorities, especially with regard to relationships. Less expectedly, this study shows that, despite sophisticated knowledge of anatomy and physiology, almost half the heart recipients had an overt or covert notion of potentially acquiring some of the donor's personality characteristics along with the heart. The concomitance of the magical and the logical is not uncommon in many areas of human existence, and is probably enhanced by the symbolic nature of the heart, and maybe, also, by the persistent stress that requires an ongoing, emotionally intense, adaptation process.
Adaptation, Psychological↗
Sources of anticipatory distress among breast surgery patients.
Surgical consultation concerning the possibility of breast cancer is a distressing experience, and having to take the next step of breast surgery even more so for many women. However, the sources of variability in such presurgical distress are not well understood. Sixty-one women (mean age = 51) were recruited immediately following surgical consultation in which a recommendation of breast surgery (excisional biopsy/lumpectomy) was made. Patients completed measures of distress, worry about cancer and surgery, trait anxiety, optimism and pessimism prior to surgery. Surprisingly, results revealed no effect of surgeon-provided information concerning preliminary diagnosis on patient distress. Rather, worry about what the surgeon might find concerning the breast mass during surgery, worry about having to go through the operative procedures, and patient optimism were the only factors that uniquely contributed to patient distress (p's < 0.05). This study provides a foundation for future clinical interventions to reduce presurgery distress.
Adaptation, Psychological↗
Romanian norms for the Harvard Group Scale of Hypnotic Susceptibility, Form A.
A Romanian-language version of the Harvard Group Scale of Hypnotic Susceptibility, Form A (HGSHS:A) was administered to 340 subjects (218 females and 122 males) recruited from 1998 to 1999 in Romania. Data were collected from three samples of participants to provide greater heterogeneity within the sample. The results from the Romanian version of the HGSHS:A were compared to those from Australian, Canadian, Danish, Finnish, German, Italian, Spanish, and original U.S. samples. The Romanian normative data are consistent with earlier normative studies in score distribution, item difficulty levels, and reliability. The mean score of the Romanian sample did not differ from those in the German and Italian samples but did significantly differ from the remaining samples. The total score reliability (.71) and item reliability of the Romanian sample was also comparable with published reference samples. No differences between women and men were found.
Adolescent↗
The impact of different directed forgetting instructions on implicit and explicit memory: new evidence from a modified process dissociation procedure.
In contrast to previous research on directed forgetting, the present studies adopted a recent modification of the process dissociation procedure (Jacoby, 1991; Richardson-Klavehn & Gardiner, 1995) to accommodate the cross-contamination of memory test performance by implicit and explicit memorial factors. In Experiment 1, 120 subjects were compared in global directed forgetting, item-by-item directed forgetting, and control conditions on estimates of voluntary conscious memory, involuntary conscious memory, and involuntary unconscious memory performance. In Experiment 2, 80 subjects were compared in specific directed forgetting and control conditions on estimates of voluntary conscious memory, involuntary conscious memory, and involuntary unconscious memory performance. Subjects showed significant decrements in voluntary and involuntary conscious memory performance following instructions for directed forgetting in all conditions. None of the directed forgetting conditions showed a decrement in involuntary unconscious memory performance. Results suggest that, regardless of instruction type, directed forgetting prevents the conscious expression of memorial information (both voluntary and involuntary) while leaving unconscious memory intact.
Adult↗
Trajectories of posttraumatic stress disorder following myocardial infarction: a prospective study.
BACKGROUND: This study examines the trajectories of posttraumatic stress disorder (PTSD) following myocardial infarction (MI). More specifically, it has 2 aims: (1) to examine whether the trajectory of PTSD is predicted by level of threat and the nature of initial reactions and (2) to examine the associations between the trajectory of PTSD and anxiety, somatization, health-related quality of life, and hospitalization 7 months following MI. METHOD: 116 MI patients were examined twice. At time 1, within a week of the patient's MI, acute stress disorder (ASD) was assessed and medical measures were obtained from patients' hospital records. At time 2, 7 months later, PTSD, anxiety, physical residuals, and health-related quality of life were assessed. Data were gathered in 1999. RESULTS: Six percent of the respondents had both ASD and PTSD, 10% did not have ASD but did have PTSD, and 12% had ASD but not PTSD. The trajectory of PTSD was associated with severity of anxiety, somatic complaints, and health-related quality of life. In addition, while the severity of MI did not predict the trajectory of PTSD, the perceived severity did. Patients without PTSD but with prior ASD did not differ in their initial reactions from those without ASD. CONCLUSION: These findings provide support for the considerable variability in the trajectory of the development of PTSD and suggest that although ASD is associated with subsequent PTSD, the predictive role of initial reactions is limited.
Aged↗
Suggestibility and negative priming: two replication studies.
Research suggests that inhibiting the effect of irrelevant stimuli on subsequent thought and action (cognitive inhibition) may be an important component of suggestibility. Two small correlation studies were conducted to address the relationship between different aspects of suggestibility and individual differences in cognitive inhibition, operationalized as the degree of negative priming generated by to-be-ignored stimuli in a semantic categorization task. The first study found significant positive correlations between negative priming, hypnotic suggestibility, and creative imagination; a significant negative correlation was obtained between negative priming and interrogative suggestibility, demonstrating the discriminant validity of the study results. The second study replicated the correlation between negative priming and hypnotic suggestibility, using a different suggestibility measurement procedure that assessed subjective experience and hypnotic involuntariness as well as objective responses to suggestions. These studies support the notion that the ability to engage in cognitive inhibition may be an important component of hypnotic responsivity and maybe of other forms of suggestibility.
Adult↗
The effectiveness of adjunctive hypnosis with surgical patients: a meta-analysis.
UNLABELLED: Hypnosis is a nonpharmacologic means for managing adverse surgical side effects. Typically, reviews of the hypnosis literature have been narrative in nature, focused on specific outcome domains (e.g., patients' self-reported pain), and rarely address the impact of different modes of the hypnosis administration. Therefore, it is important to take a quantitative approach to assessing the beneficial impact of adjunctive hypnosis for surgical patients, as well as to examine whether the beneficial impact of hypnosis goes beyond patients' pain and method of the administration. We conducted meta-analyses of published controlled studies (n = 20) that used hypnosis with surgical patients to determine: 1) overall, whether hypnosis has a significant beneficial impact, 2) whether there are outcomes for which hypnosis is relatively more effective, and 3) whether the method of hypnotic induction (live versus audiotape) affects hypnosis efficacy. Our results revealed a significant effect size (D = 1.20), indicating that surgical patients in hypnosis treatment groups had better outcomes than 89% of patients in control groups. No significant differences were found between clinical outcome categories or between methods of the induction of hypnosis. These results support the position that hypnosis is an effective adjunctive procedure for a wide variety of surgical patients. IMPLICATIONS: A meta-analytical review of studies using hypnosis with surgical patients was performed to determine the effectiveness of the procedure. The results indicated that patients in hypnosis treatment groups had better clinical outcomes than 89% of patients in control groups. These data strongly support the use of hypnosis with surgical patients.
Anesthesia↗
A Comparison of the Cough Profile of Fosinopril and Enalapril in Hypertensive Patients with a History of ACE Inhibitor-Associated Cough.
OBJECTIVE: Cough frequency and severity with fosinopril and enalapril were assessed in hypertensive patients with previous angiotensin-converting enzyme inhibitor (ACEI)-associated cough. DESIGN: Prospective, multicenter, randomized, 8-week double-blind treatment. PATIENTS: One hundred seventy-nine patients (mild-to-moderate hypertension, nonsmokers, mean age 58 years; 55% females; 72% Caucasian, 6% black, 19% Hispanic) were studied. Patients with other cough etiologies, significant co-morbidity, or confounding medications were excluded. INTERVENTIONS: Patients were randomized to fosinopril 10 mg (n = 85) or enalapril 5 mg (n = 94) once daily. Dosage could be doubled for blood pressure control after 4 weeks. Outcome measurements: The primary end point was all-cough frequency based on patient daily diary ratings; a cumulative cough frequency score was calculated. Secondary end points included cough severity, nonproductive cough frequency, night awakenings, cough time of day, and spontaneously reported cough. RESULTS: Fosinopril and enalapril demonstrated similar blood pressure control. Significant cough profile differences were observed in favor of fosinopril: all-cough frequency was 40.6 plus minus 3.8 (mean plus minus SE) versus 52.8 plus minus 3.6 (p = 0.02); nonproductive cough frequency was 26.7 plus minus 3.5 versus 40.3 plus minus 3.4 (p less-than-or-equal 0.01); and cough time of day was 49.2 plus minus 5.2 versus 66.0 plus minus 5.0 (p = 0.02), for fosinopril and enalapril, respectively. Subgroup analysis revealed all-cough frequency was 33.5 plus minus 6.3 versus 56.6 plus minus 5.3 (p = 0.006) for fosinopril and enalapril, respectively, in patients who previously had cough on one of these two ACEI (predominantly enalapril). Ten (12%) fosinopril and 25 (27%) enelapril patients spontaneously reported cough (p = 0.01). CONCLUSIONS: Hypertensive patients with previous ACEI-associated cough reported less frequent cough with fosinopril compared to enalapril, based on cumulative patient diary scores and spontaneously reported cough. This difference was most apparent in the subgroup of patients who previously experienced cough associated with enalapril therapy. Patients with prior ACEI-associated cough may experience less frequent with fosinopril.
Journal Article↗