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Social anxiety disorder (SAD) often involves difficulty developing relationships. Facial expressions are important in relationship formation, but data are limited regarding facial display production among persons with SAD during social interaction. The current study compared facial displays of individuals diagnosed with SAD (n= 41) to control participants (n= 24) as they interacted with a confederate; confederates and observers then rated their desire for future interaction with participants. Automated software used the Facial Action Coding System to classify displays. During portions of the interaction that involved listening to partners, the SAD group smiled less frequently and less intensely than controls, and less smiling was associated with others’ lower desire for future interaction with participants. Diminished positive facial affect in response to interaction partners may disrupt relationship formation in SAD and may serve as an effective treatment target.

Intolerance of uncertainty (IU) has been proposed as a transdiagnostic risk and maintenance factor underlying various forms of psychopathology. Few studies, however, have examined IU in hoarding disorder (HD)—a condition characterized by excessive urges to acquire and difficulties discarding possessions—core symptoms that may be fueled by inflated IU. We examined cross-sectional relationships between IU and different symptom facets of HD, controlling for anxiety and depression severity, and explored whether pre-treatment levels of IU predicted response to exposure-based treatment for HD.

Individuals with social anxiety disorder (SAD) are motivated to conceal what they perceive to be personal inadequacies. They recognize, however, that their behavior does not convey who they genuinely are. Here, we examined whether increasing perceived authenticity facilitates positive social functioning in these individuals. Participants diagnosed with SAD (N= 72) engaged in two social interactions with experimental confederates. Prior to the second interaction, participants were randomly assigned to one of two conditions equated on all elements except a safety behavior reduction procedure intended to increase self-authenticity. As hypothesized, increased authenticity led to beneficial changes in the cognitive, affective, and motivation processes that promote relational functioning. These results suggest that the experience of expressing one’s authentic self may reduce SAD-related social impairment.

It is now well established that cognitive behavioral therapy (CBT) is efficacious in the treatment of social anxiety disorder (SAD). Although previous research supports the cognitive proposition that clinical improvement in CBT is achieved in part through the modification of distorted judgment processes, little is known about the specific nature of the judgment biases that are important in the treatment of pathological social fear. To address this issue, the extent to which early changes in self–– and interpersonal––judgment biases are associated with later changes in symptoms during treatment in a sample of patients diagnosed with generalized SAD were assessed. Pre-, mid-, and posttreatment measures of social anxiety symptoms and judgment biases were collected from patients completing a 12––week group interpersonal––CBT program for SAD (n = 19) and from patients assigned to a waitlist control condition (n= 23). Results revealed that reductions in patients' judgments about the likelihood that others would respond negatively to them and the emotional cost should they do so (i.e., interpersonal judgments) preceded and correlated with treatment outcome. Moreover, decreases in the degree to which patients' self––evaluations were contingent upon interpersonal feedback were also associated with social anxiety reduction. These findings are discussed in relation to contemporary theories of SAD, and implications for treatment are considered.

OBJECTIVE To review recent advances in the prevention of venous thromboembolism (VTE) in acutely ill nonsurgical inpatients.DATA SOURCES A MEDLINE search (1966–March 2005) was done to identify relevant articles relating to prevention of VTE in acutely ill nonsurgical inpatients.STUDY SELECTION AND DATA EXTRACTION Four major prophylaxis trials, one registry, one guideline, and supporting articles representative of the subject matter from the last few years were included.DATA SYNTHESIS Enoxaparin, dalteparin, fondaparinux, and unfractionated heparin 5000 units every 8 hours are effective in reducing the risk of VTE in acutely ill medical patients, but such prophylaxis is currently underused. Barriers to be overcome include recognition of the importance of VTE in this population, definition of the optimal strategy to assess risks, optimal timing of the risk assessment, optimal prophylactic regimen for a given level of risk or disease state, and optimal duration of prophylaxis. We recommend that acutely ill medical inpatients should be risk-stratified early in their hospitalization. At this time, the specific risk-assessment protocol should be derived from the trial(s) of the available formulary agent(s). Decisions about providing prophylaxis must also be made considering anticoagulant contraindications and renal function. Mechanical methods of prophylaxis should be considered as monotherapy only if an anticoagulant contraindication exists. The optimal duration of prophylaxis is not known, but 14 days was used in recent studies.CONCLUSIONS Prophylaxis of VTE in acutely ill medical inpatients is underused. Data provide some guidance for increasing awareness and optimizing patient care.

AbstractAlthough social avoidance is a defining feature of avoidant personality disorder (APD), some theorists posit that APD is characterized by a broader pattern of avoidance that extends beyond social situations. This paper describes a series of four studies that examined the different types of nonsocial avoidance hypothesized to characterize APD in three undergraduate student samples and a clinical sample of adults with APD. Overall, the findings revealed low to moderate associations between APD and emotional and novelty avoidance, as well as avoidance of various nonsocial events. The results provide support for contemporary models of APD.

AbstractAvoidant Personality Disorder (APD) is the topic of a growing body of research literature. In this article, we review empirical studies of APD with the goals of identifying the themes that underlie this work and pointing to new directions for future research. In particular, we recommend that future studies evaluate several unique factors postulated by personality theorists to be central to this condition.

To determine the safety and effectiveness of ibutilide, we conducted a retrospective study of patients in a community hospital from December 1997‐January 2000, reviewing hospital and pharmacy records for 12 inpatients (aged 68 ± 13 yrs) receiving ibutilide for atrial fibrillation or flutter. The cumulative conversion rate with ibutilide 0.012 ± 0.004 mg/kg was 58%. Serious cardiovascular adverse events were documented in six patients; of those patients, five had baseline QTc intervals above 440 msec, two experienced ventricular fibrillation, and four experienced symptomatic bradycardia (range 49–60 beats/minute) requiring medical intervention. The effectiveness of ibutilide was similar to that found in previous studies. However, more complications were seen in this setting where ibutilide was used infrequently and without stringent patient selection criteria or standardized administration protocols. To ensure optimal patient care, institutions should consider implementing guidelines or education strategies to reduce the potential for serious adverse effects associated with improper screening, dosing, and monitoring of patients receiving ibutilide.

OBJECTIVE: To evaluate safety and efficacy of corticotropin for acute gout.DATA SOURCES: Clinical literature was accessed through MEDLINE (1966–August 2000). Key search terms included gout, ACTH, adrenocorticotropic hormone, and corticotropin.DATA SYNTHESIS: Joint pain and local signs of inflammation characterize gout. Acutely, colchicine and nonsteroidal antiinflammatory drugs (NSAIDs) are first-line therapy. Adverse effects or concomitant diseases limit therapy and necessitate alternative options. An evaluation of studies involving corticotropin was conducted.CONCLUSIONS: Corticotropin alone or in combination with colchicine was more rapidly effective and associated with fewer adverse effects than indomethacin. This regimen may be considered an alternative, especially for patients with medical problems in which other regimens are contraindicated.

Staff development programs have been developed by national pharmacy organizations to improve clinical skills and expand the services offered by pharmacists. Most of these programs do not involve the training of other health care professionals. This article describes an anticoagulation training program designed not only for pharmacists, but for physicians and nurses as well. For pharmacists, the effectiveness of educational interventions was assessed by pretest/post-test/surveys with an average increase of 38% from baseline (p < 0.01). The knowledge gained by physicians and nurses is an ongoing process evaluated by follow-up warfarin medication use evaluations and prospective weight-based heparin protocol evaluations. The goal of staff development should be to equip each member of the health care team with the knowledge needed to improve patient outcomes.

OBJECTIVE: To describe the influence of pharmacy faculty, residents, and students at a community hospital by documenting the number and types of interventions attributable to their involvement in patient-care activities.METHODS: Between September 1, 1997, and May 31, 1999, data were collected using a computerized documentation system to characterize the intervention type, significance, and value of services rendered by an education group composed of pharmacy faculty (n = 2), residents (n = 4), and students (n = 22).RESULTS: The number, nature, and outcome category for all interventions were documented using an existing computerized documentation system. The education group accounted for 13% (n = 2873) of total clinical activities documented (n = 21 817). The most common activities reported were discharge counseling/education (31%), consultation by physicians and therapeutic recommendations (15%), and route conversion (6%). Interventions documented by the education group were classified as medium or high significance 50% of the time. Sixteen percent ($172 655) of the estimated cost avoidance documented by the pharmacy department was attributed to the education group.CONCLUSIONS: This study demonstrates that educational activities by pharmacy faculty, residents, and students have a positive influence on patient care in a community hospital.

Study Objective. To measure the difference in therapeutic ranges of activated partial thromboplastin time (APTT) between two laboratory devices.

A 39‐year‐old woman being treated for osteomyelitis with vancomycin developed severe neutropenia and drug fever. After she discontinued therapy, both disorders quickly resolved. These adverse reactions have rarely been reported with vancomycin, and share many similarities with regard to clinical features and postulated mechanisms of induction. To our knowledge this is the first case documenting drug fever as a principal component of vancomycin‐induced neutropenia, and provides further evidence in support of an immune‐mediated mechanism.

We conducted an extensive literature review to evaluate the appropriate use, route, and dose of vitamin K to reverse excessive anticoagulation. Issues such as sample size, study design, different patient populations, and various study end points confounded results. Of 18 studies published, 8 enrolled 229 patients to evaluate parenteral vitamin K administration. Nine studies with 288 patients evaluated oral administration, and only 2 retrospective studies (280 patients) compared routes of administration. Reductions in international normalized ratios at 24 hours ranged from 21–42%, 47–86%, 25–67%, and 40–75% for temporary warfarin discontinuation alone, and intravenous, subcutaneous, and oral routes of vitamin K administration, respectively. Methodologically weak studies and indeterminate results plague interpretation of the literature on vitamin K. In general, results of this review support current guidelines for reversing excessive warfarin anticoagulation. However, it is important to realize that the quality of literature on which these recommendations are based is poor and that optimal dose and route of vitamin K administration remain unclear. Large, well‐designed, randomized, controlled trials are necessary to define optimum management strategies for excessively anticoagulated patients.

OBJECTIVE: To describe the use of intravenous immune globulin (IVIG) to treat Wegener's granulomatosis (WG) in an adolescent female with an abnormal magnetic resonance imaging (MRI) scan and electroencephalogram (EEG), as well as central nervous system involvement manifesting as generalized seizures.CASE SUMMARY: A 15-year-old white girl diagnosed with WG and receiving prednisone and cyclophosphamide was admitted with new-onset tonic–clonic seizures. The patient received phenobarbital and phenytoin to control seizures and was receiving cyclophosphamide and corticosteroids for WG. She developed cyclophosphamide-induced cystitis and was started on a four-day therapeutic course of IVIG following the discontinuation of cyclophosphamide. After 16 days of hospitalization, repeat EEG and MRI were within normal limits, and laboratory and clinical improvement was evident in at least nine of the affected organ systems including pulmonary, hematologic, renal, ocular, cutaneous, musculoskeletal, central nervous system, gastrointestinal, and genitourinary. The patient was discharged with clinical involvement of WG documented in two organ systems, hematologic and renal.DISCUSSION: WG is a form of vasculitis believed to develop due to an autoimmune disorder. The diagnosis is based on radiographic and histopathologic findings, as well as the presence of elevated antineutrophil cytoplasmic antibodies and a suggestive clinical presentation. The presentation is widely variable and is most commonly associated with upper-airway involvement such as sinusitis, cough, pulmonary infiltrates, and cavitary nodules. Renal involvement signifies generalized disease. Conventional treatment for WG includes cyclophosphamide and prednisone. Little information is available describing therapeutic alternatives. Cytotoxicity related to immunosuppressant regimens limits continuous treatment and may necessitate the use of alternative agents.CONCLUSIONS: This case describes the use of IVIG in an adolescent patient presenting with WG as a generalized, active disease with neurologic complications. IVIG may be useful in generalized, active WG complicated by intolerance to cyclophosphamide and seizures, but further study is necessary to define its role.

•What is the primary question addressed by this study?•We investigated the association of positive affect with loneliness and complementary aspects of social functioning beyond negative affect, an established correlate of loneliness, among 429 older adults.•What is the main finding of the study?•Positive affect was found to be significantly predictive of social functioning variables of loneliness, companionship, and satisfaction with social activities, independent of negative affect and when controlling for relevant demographic characteristics.•What is the meaning of the finding?•Given that positive affect likely facilitates greater social connectedness, positive affect-targeted interventions may improve social connectedness and reduce loneliness for older adults.

The heterogeneous nature of mood and anxiety disorders highlights a need for dimensionally based descriptions of psychopathology that inform better classification and treatment approaches. Following the Research Domain Criteria approach, this investigation sought to derive constructs assessing positive and negative valence domains across multiple units of analysis.

Objectives. To determine if the addition of a student-supported venous thromboembolism risk assessment strategy could improve rates of venous thromboembolism prophylaxis at a community teaching hospital.

Presents letters to the editor referencing articles and topics discussed in previous issues. "How I Trapped My Fellow Cops," which focused on the courageous personal sacrifices of Captain Todd O. Thoman, Jr.; "The Secret of the Bottle," which is a novelette by Gerald Kersh; "A Law of the Land Needs a Firmer Base Than Court Decisions," which dealt judgments based on the U.S. constitution.