Cognitive-behavioral therapy for anxiety in Parkinson's disease

Parkinson's disease (PD) is characterized by motor symptoms, but nonmotor symptoms also significantly impair daily functioning and reduce quality of life. Anxiety is prevalent and debilitating in PD, but remains understudied and undertreated. Much affective research in PD focuses on depression rather than anxiety, and as such, there are no evidence-based treatments for anxiety in this population. Cognitive-behavioral therapy (CBT) has shown promise for treating depression in PD and may be efficacious for anxiety. This exploratory study implemented a multiple-baseline single-case experimental design to evaluate the utility and feasibility of CBT for individuals with PD who also met criteria for a DSM-5 anxiety disorder ( n = 9). Participants were randomized to a 2-, 4-, or 6-week baseline phase, followed by 12 CBT sessions, and two post treatment assessments (immediately post treatment and 6-week follow-up). Multiple outcome measures of anxiety and depression were administered weekly during baseline and intervention. Weekly CBT sessions were conducted in-person ( n = 5) or via secure videoconferencing ( n = 4). At post treatment, seven of the nine participants showed significant reductions in anxiety and/or depression, with changes functionally related to treatment and most improvements maintained at 6-week follow-up. Effects of CBT on secondary outcomes varied across participants, with preliminary evidence for reduction in fear of falling. Adherence and retention were high, as were treatment satisfaction and acceptability. The findings of this pilot study provide preliminary evidence for the utility of CBT as a feasible treatment for anxiety and comorbid depressive symptoms in PD and highlight the potential of telehealth interventions for mood in this population.Accepted manuscrip

Evidence for Rotation in the Galaxy at z=3.15 Responsible for a Damped Lyman-alpha Absorption System in the Spectrum of Q2233+1310

Proof of the existence of a significant population of normal disk galaxies at redshift z>2 would have profound implications for theories of structure formation and evolution. We present evidence based on Keck HIRES observations that the damped Lyman-alpha absorber at z=3.15 toward the quasar Q2233+1310 may well be such an example. Djorgovski et al have recently detected the Lyman-alpha emission from the absorber, which we assume is at the systemic redshift of the absorbing galaxy. By examining the profiles of the metal absorption lines arising from the absorbing galaxy in relation to its systemic redshift, we find strong kinematical evidence for rotation. Therefore the absorber is likely to be a disk galaxy. The inferred circular velocity for the galaxy is >200 km/s. With a separation of ~17 kpc between the galaxy and the quasar sightline, the implied dynamic mass for the galaxy is >1.6x10(11) solar mass. The metallicity of the galaxy is found to be [Fe/H]=-1.4, typical of damped Lyman-alpha galaxies at such redshifts. However, in another damped galactic rotation is evident. In the latter case, the damped Lyman-alpha absorber occurs near the background quasar in redshift so its properties may be influenced by the background quasar. These represent the only two cases at present for which the technique used here may be applied. Future applications of the same technique to a large sample of damped Lyman-alpha galaxies may allow us to determine if a significant population of disk galaxies already existed only a few billion years after the Big Bang.Comment: AASTEX, 2 PS figures, accepted by ApJ, 6 pages total, replaced on 1-22-97, the only change is the enlarged figure

Keck High Resolution Spectroscopy of PKS 0123+257: Intrinsic Absorption in a Radio Loud Quasar

We present results from Keck I high resolution spectroscopy of the radio loud quasar PKS 0123+257 ($z_e$=2.364, V=17.5). In this object we detect Ly$\alpha$, N V 1238,1242, Si IV 1393,1402, and C IV 1548,1550 in an absorption system at a redshift of 2.369. The Ly$\alpha$ line has a square- bottomed profile suggesting a high column density of gas, yet the line does not reach zero intensity. The resolved C IV doublet ratio also clearly demonstrates that the absorbing clouds at this redshift do not fully occult the background light source along our line-of-sight. The absorption lines are positioned near the centers of the broad emission- lines and the coverage fraction of the strongest absorption lines varies inversely proportionally with the strength of the corresponding emission lines. This implies that although the absorption-line region may obscure the continuum source, it does not completely occult the broad emission-line region. This effect suggests that the lines are formed close to the QSO central region. A model is proposed in which the apparent coverage fraction derived for the weaker absorption lines may vary with the column density of the lines. Broad absorption-lines (which are known to be intrinsic) are found nearly exclusively in radio-quiet objects. Intrinsic narrow absorption lines have previously been found in radio quiet QSOs; it is therefore significant that an intrinsic absorption system has been verified in a radio loud quasar.Comment: 16 pages with 5 figures, AAS LaTex v4.0. To appear in the Astronomical Journal, January 199

Expansion and Collapse in the Cosmic Web

We study the kinematics of the gaseous cosmic web at high redshift with Lyman alpha forest absorption in multiple QSO sightlines. Using a simple analytic model and a cosmological hydrodynamic simulation we constrain the underlying three-dimensional distribution of velocities from the observed line-of-sight distribution of velocity shear across the plane of the sky. The distribution is found to be in good agreement with the intergalactic medium (IGM) undergoing large scale motions dominated by the Hubble flow. Modeling the Lyman alpha clouds analytically and with a hydrodynamics simulation, the average expansion velocity of the gaseous structures causing the Lyman alpha forest in the lower redshift (z = 2) sample appears about 20 percent lower than the local Hubble expansion velocity. We interpret this as tentative evidence for some clouds undergoing gravitational collapse. However, the distribution of velocities is highly skewed, and the majority of clouds at redshifts from 2 to 3.8 expand typically about 5 - 20 percent faster than the Hubble flow. This behavior is explained if most absorbers in the column density range typically detectable are expanding filaments that stretch and drain into more massive nodes. We find no evidence for the observed distribution of velocity shear being significantly influenced by processes other than Hubble expansion and gravitational instability, like galactic winds. To avoid overly disturbing the IGM, winds may be old and/or limp by the time we observe them in the Lyman alpha forest, or they may occupy only an insignificant volume fraction of the IGM. (abridged)Comment: 63 pages, 26 figures, AAS Latex; ApJ, in pres