Avoidant Personality Disorder and Social Phobia: Identification of Clinically Meaningful Differences

Background: Both avoidant personality disorder (AVPD) and social phobia (SP) feature social fears that lead to avoidant behaviour, distress and disability. The “severity continuum hypothesis” proposes that AVPD is essentially a more severe variant of SP, but a small number of studies posit the contrary, and clinical experience suggests that AVPD is a distinct disorder. Thus far AVPD is vastly under-researched compared to SP and this thesis targets this gap and investigates the extent to which AVPD is a distinct entity from SP. Methods: A literature review of the evidence for and against the severity continuum hypothesis identified factors that may differentiate AVPD and SP, in particular attachment style. Epidemiological data was interrogated to determine the prevalence and demographic correlates of AVPD with and without SP. Prospectively recruited participants were assigned to SP-only, AVPD-only or SP+AVPD groups and compared across variables of syndromic, aetiological and therapeutic interest for AVPD. A qualitative study was conducted to characterise the core lived experience features of AVPD, further informing development of a brief clinical screening measure. Results: Australian community epidemiological data confirmed international findings of a predominance of AVPD without SP. In both epidemiological and recruited samples the comorbid group separated from SP-only in the direction of greater severity, whereas AVPD-only showed a more variable relationship. Analysis of qualitative data suggested that greater emphasis would be warranted on the perceived catastrophic meaning of rejection and sense of self, and delineated cognitive-behavioural patterns worthy of further study. The brief, easily scored screening measure offers promise for use in clinical settings. Conclusions: Support is found for an alternative to the continuum hypothesis. In this, SP and AVPD share a focus on interpersonal concerns but are sufficiently distinct to justify retaining separate diagnostic categories. The brief screening tool and findings from the qualitative study add considerably to knowledge of AVPD and the insights from this thesis are likely to be of significance, informing our approach to establishing and maintaining a therapeutic alliance with this very difficult to engage patient population

Psychoeducational social anxiety mobile apps : systematic search in app stores, content analysis, and evaluation

Background: The wide use of mobile health apps has created new possibilities in social anxiety education and treatment. However, the content and quality of social anxiety apps have been quite unclear, which makes it difficult for people to choose appropriate apps to use on smartphones and tablets. Objective: This study aims to identify the psychoeducational social anxiety apps in the two most popular Australian app stores, report the descriptive and technical information provided in apps exclusively for social anxiety, evaluate app quality, and identify whether any apps would be appropriate for people with social anxiety or others who know someone with social anxiety. Methods: This systematic stepwise app search was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) standards and entailed searching for, identifying, and selecting apps in the Australian Apple App and Google Play Stores; downloading, using, and reviewing the identified apps; reporting technical and descriptive information in the app stores, an online app warehouse, and individual apps; evaluating app quality; and deciding whether to recommend the use of the apps. Results: In the app stores, 1043 apps were identified that contained the keywords social anxiety, social phobia, or shyness in their names or descriptions. Of these, 1.15% (12/1043) were evaluated (3 iOS apps and 9 Android apps). At the time of evaluation, the apps were compatible with smartphones and tablet devices; 9 were free to download from the app stores, whereas 3 were priced between US $2.95 (Aus$3.99) and US $3.69 (Aus$5.00). Among the evaluated apps, 3 were intended for treatment purposes, 3 provided supportive resources, 1 was intended for self-assessment, and the remaining 5 were designed for multiple purposes. At the time of downloading, app store ratings were available for 5 apps. The overall app quality was acceptable according to the Mobile App Rating Scale (MARS). On the basis of the MARS app quality rating subscale (sections A-D), the apps functioned well in performance, ease of use, navigation, and gestural design. However, app quality was less favorable when rated using the MARS app subjective quality subscale (section E). Conclusions: The psychoeducational social anxiety apps evaluated in our study may benefit people with social anxiety, health professionals, and other community members. However, given that none of the apps appeared to contain empirical information or were shown to clinically reduce social anxiety (or aid in managing social anxiety), we cannot recommend their use. App accessibility could be improved by developing apps that are free and available for a wider range of operating systems, both between and within countries and regions. Information communication and technology professionals should collaborate with academics, mental health clinicians, and end users (ie, co-design) to develop current, evidence-based apps

"Utforskning på 1. trinn handler mer om å etablere en kultur for utforskning, enn den faktiske utforskningen"

Gjennom dette masterprosjektet har vi undersøkt hva det vil si å jobbe utforskende i matematikkundervisningen på 1. trinn. Utforskende matematikkundervisning har de siste årene vært aktuelt innenfor forskning i matematikkdidaktikk og har fått større plass i utdanningspolitikk og i læreplaner (Artigue & Maaß, 2013, s. 797). Ved revidering av ny læreplan, var en av de største endringene at det nå er implementert kjerneelementer i de ulike fagene. Et av kjerneelementene er utforskning og problemløsning (Kunnskapsdepartementet, 2019). I tillegg blir også verbet å utforske nevnt hyppig i kompetansemålene i LK20. Maaß og Reitz-Koncebovski (2013, s. 10) beskriver utfordringer med å endre undervisningen fra den mer tradisjonelle til utforskende. Både elever og læreren må venne seg til en ny måte å lære på og å undervise på, som kan by på utfordringer i starten. Masteroppgaven tar utgangspunkt i følgende problemstilling: Hva vil det si å jobbe utforskende i matematikkundervisningen på 1. trinn? For å besvare problemstillingen har vi utført en kvalitativ studie. Vi har gjennomført observasjoner av tre utforskende undervisningsøkter i en 1. klasse. Undervisningsøktene har vi har planlagt sammen med læreren, vi har intervjuet læreren på trinnet og vi har gjennomført oppgavebaserte intervju med utvalgte elever. Dette har gitt oss et innblikk i hvordan utforskende matematikkundervisning kan se ut i 1. klasse. Gjennom forskningen vår har vi kommet frem til tre funn som kan være avgjørende for å kunne gjennomføre utforskende matematikkundervisning på 1. trinn. De tre funnene er å etablere en læringskultur for utforskning, lærerens planlegging og grep under gjennomføringen av utforskende matematikkundervisning og at elevene responderer ulikt på undervisningen avhengig av oppgavetypen. Lærerens rolle ble sentral for å kunne etablere utforskning som undervisningspraksis

Managing anxiety disorders in adults

The GP has a key role in identifying patients presenting with anxiety symptoms and ensuring appropriate acute and long-term management. There are two key messages for GPs to follow: once you have made a diagnosis of an anxiety disorder, tell the patient you have a treatment for it. Second, do not let your anxiety lead you to prescribe inappropriately or overinvestigate for all possible differential diagnoses

Tissue-specific patterns of gene expression in the epithelium and stroma of normal colon in healthy individuals in an aspirin intervention trial

AbstractRegular aspirin use reduces colon adenoma and carcinoma incidence. UDP-glucuronosyltransferases (UGT) are involved in aspirin metabolism and clearance, and variant alleles in UGT1A6 have been shown to alter salicylic acid metabolism and risk of colon neoplasia. In a randomized, cross-over, placebo-controlled trial of 44 healthy men and women, homozygous for UGT1A6*1 or UGT1A6*2, we explored differences between global epithelial and stromal expression, using Affymetrix U133+2.0 microarrays and tested effects of 60-day aspirin supplementation (325mg/d) on epithelial and stromal gene expression and colon prostaglandin E2 (PGE2) levels. We conducted a comprehensive study of differential gene expression between normal human colonic epithelium and stroma from healthy individuals. Although no statistically significant differences in gene expression were observed in response to aspirin or UGT1A6 genotype, we have identified the genes uniquely and reproducibly expressed in each tissue type and have analyzed the biologic processes they represent. Here we describe in detail how the data, deposited in the Gene Expression Omnibus (GEO) – accession number GSE71571 – was generated including the basic analysis as contained in the manuscript published in BMC Medical Genetics with the PMID 25927723 (Thomas et al., 2015 [9])

A20 regulates lymphocyte adhesion in murine neuroinflammation by restricting endothelial ICOSL expression in the CNS.

A20 is a ubiquitin-modifying protein that negatively regulates NF-κB signaling. Mutations in A20/TNFAIP3 are associated with a variety of autoimmune diseases, including multiple sclerosis (MS). We found that deletion of A20 in central nervous system (CNS) endothelial cells (ECs) enhances experimental autoimmune encephalomyelitis (EAE), a mouse model of MS. A20∆CNS-EC mice showed increased numbers of CNS-infiltrating immune cells during neuroinflammation and in the steady state. While the integrity of the blood-brain barrier (BBB) was not impaired, we observed a strong activation of CNS-ECs in these mice, with dramatically increased levels of the adhesion molecules ICAM-1 and VCAM-1. We discovered ICOSL as adhesion molecule expressed by A20-deficient CNS-ECs. Silencing of ICOSL in CNS microvascular ECs partly reversed the phenotype of A20∆CNS-EC mice without reaching statistical significance and delayed the onset of EAE symptoms in wildtype mice. In addition, blocking of ICOSL on primary mouse brain microvascular endothelial cells (pMBMECs) impaired the adhesion of T cells in vitro. Taken together, we here propose that CNS EC-ICOSL contributes to the firm adhesion of T cells to the BBB, promoting their entry into the CNS and eventually driving neuroinflammation

Depression and sickness behavior are Janus-faced responses to shared inflammatory pathways

It is of considerable translational importance whether depression is a form or a consequence of sickness behavior. Sickness behavior is a behavioral complex induced by infections and immune trauma and mediated by pro-inflammatory cytokines. It is an adaptive response that enhances recovery by conserving energy to combat acute inflammation. There are considerable phenomenological similarities between sickness behavior and depression, for example, behavioral inhibition, anorexia and weight loss, and melancholic (anhedonia), physio-somatic (fatigue, hyperalgesia, malaise), anxiety and neurocognitive symptoms. In clinical depression, however, a transition occurs to sensitization of immuno-inflammatory pathways, progressive damage by oxidative and nitrosative stress to lipids, proteins, and DNA, and autoimmune responses directed against self-epitopes. The latter mechanisms are the substrate of a neuroprogressive process, whereby multiple depressive episodes cause neural tissue damage and consequent functional and cognitive sequelae. Thus, shared immuno-inflammatory pathways underpin the physiology of sickness behavior and the pathophysiology of clinical depression explaining their partially overlapping phenomenology. Inflammation may provoke a Janus-faced response with a good, acute side, generating protective inflammation through sickness behavior and a bad, chronic side, for example, clinical depression, a lifelong disorder with positive feedback loops between (neuro)inflammation and (neuro)degenerative processes following less well defined triggers