The following pieces are culled from the excellent email list run by Ken Pope. We thank him again for his continued efforts. (Ed.)

Satisfaction Guaranteed: The Effect of Spatial Biases on Responses to Likert Scales. Psychological Science. Vol. 17, #12. M. Nicholls, C. Orr, M. Okubo, A. Loftus.

“Surveys play a pivotal role in research and decision making. Opinions are commonly assessed by having participants respond using a linear Likert scale (e.g., 1 to 5).

Surveys containing Likert scales employ a number of techniques to increase their construct validity, such as including occasional reversed items to maintain attention. One factor that is almost never controlled, however, is the direction in which the scale runs. Thus, for all questions within a given survey, the scale runs in the same direction from left to right. Such a design may be vulnerable to the effects of pseudoneglect--a phenomena well known to behavioral neuroscience.”

“When people respond to Likert scales, pseudoneglect may increase the salience of categories on the left relative to those on the right, causing a deviation to the left to balance the left and right sides of the scale. We investigated the effect of perceptual asymmetries on responses to Likert scales using the National Student Satisfaction Scale, recently given to 250,000 university graduates by the Higher Education Funding Council for England (HEFCE). The original questionnaire had a descending scale with favorable responses located on the left. To test whether the descending format inflated satisfaction
scores, we devised an ascending scale with favorable responses located on the right. We also measured handedness, to investigate whether simple mechanical biases might affect responses. …favorable responses were overrepresented for the descending scale, whereas unfavorable responses were overrepresented for the ascending scale.... For responses away from the mode..., survey direction had a strong impact, resulting in more ‘definitely agree’ responses for the descending scale than for the ascending scale... and more ‘mostly disagree’ responses for the ascending scale than for the descending scale...”

“Surveys traditionally control response biases by including questions with reversed meanings. Although this technique partially solves the problem, the number of items with original and reversed meanings is rarely balanced. To control the leftward bias effectively, half of the respondents should complete a survey with an ascending scale, and the other half should use a descending scale. By taking an average of responses to the two surveys, one can obtain an accurate indication of opinion. If researchers want to paint a rosy picture, however, they should place the favorable categories on the left.”

In Rigorous Test, Talk Therapy Works for Panic Disorder. B. Carey. New York Times. 2/6/07.

Last week, a team of New York analysts published the first scientifically rigorous study of a short-term variation of the therapy for panic disorder, a very common form of anxiety. The study was small, but the therapy proved to be surprisingly effective in a group of severely disabled people. The paper, which appeared in psychiatry’s flagship journal, The American Journal of Psychiatry. …Unlike traditional psychoanalysis, it focused on relieving symptoms quickly, and was time-limited. After 12 weeks, 39 percent of those working with relaxation techniques improved significantly on standard measures of anxiety and reported fewer panic-related problems in their relationships and work. But almost three-quarters of those receiving psychodynamic therapy reported similar benefits.

Study Puts Rate of Autism at 1 in 150 U.S. Children. B Carey. New York Times. 2/9/07

About one child in 150 develops autism or a related disorder like Asperger’s syndrome by the age of 8, according to a study released yesterday by the Centers for Disease Control and Prevention. The study, which looked at cases of so-called autism spectrum disorders in 14 states in 2000 and 2002, is the most rigorous analysis to date of the disorders’ prevalence in the United States. It confirms recent estimates, which put the number at roughly one in 160 children -- higher than the one-in-200 estimate made in the 1980s.

Antipsychotic Drugs’ Link to Weight Gain Found. G. Naik. Wall Street Journal. 2/13/07.

Scientists say they have pinpointed a mechanism in the brain that helps explain why certain antipsychotic drugs can trigger increased appetite and potentially dangerous weight gain in patients. The latest study, appearing in the Proceedings of the National Academy of Sciences, links a class of antipsychotics to brain chemicals that regulate appetite. The mechanism was discovered in mice; a similar link still needs to be established in people. … Past studies showed how antipsychotics can block the histamine H1 receptor, although none had shown the specific connection with weight gain, he says. The Johns Hopkins team now had a possible explanation: the role of AMPK. In tests on mice, the scientists found that by blocking the H1 receptor site they could increase AMPK activity to the same extent that clozapine did. In a more compelling experiment, they gave the drug to genetically engineered mice lacking the H1 receptor and found that clozapine didn’t increase AMPK activity. The research had established the three-way link between the drug, the histamine receptor and the change in activity of AMPK.

People Can Learn Markers On Road to Resilience. D. Milne. Psychiatric News. Vol 42, no. 2.

10 ideas to improve reslience in patients. 1) Be optimistic. 2) Develop cognitive flexibility. 3) Develop a shatterproof set of beliefs. 4) Be altruistic. 5) Find a resilient role model in a mentor or hero. 6) Learn to be adept at facing your fears. 7) Develop active coping skills. 8) Establish and nurture a social support network. 9) Keep physically fit. 10) Have a sense of humor and laugh frequently.

51% of Women Are Now Living Without Spouse. S. Roberts. New York Times. 1/16/07.

For what experts say is probably the first time, more American women are living without a husband than with one. In 2005, 51 percent of women said they were living without a spouse, up from 35 percent in 1950 and 49 percent in 2000. Coupled with the fact that in 2005 married couples became a minority of all American households for the first time, the trend could ultimately shape social and workplace policies, including the ways government and employers distribute benefits.

FDA approves ADHD drug Vyvanse. Associated Press. 2/24/07

A new amphetamine-based drug to treat attention deficit hyperactivity disorder won federal approval Friday. It’s harder to abuse than older stimulants, the manufacturer says. Also known as lisdexamfetamine, the drug is made by Shire PLC. Shire hopes the drug will extend its lucrative ADHD franchise once its top-selling Adderall XR begins facing competition from lower-priced generic versions in 2009. Shire plans to move patients from the older to the newer drug at the time. Vyvanse works by gradually releasing its active ingredient, d-amphetamine, after the drug has been swallowed and comes into contact with enzymes in the digestive tract. Unless it’s swallowed, Vyvanse remains inactive. Shire believes that will curtail its potential for abuse by users who snort or inject crushed pills. Britain’s Shire said earlier this month it would spend roughly $2.6 billion to buy New River Pharmaceuticals Inc., the Radford, Virginia, company that originally developed Vyvanse.

Study: Ibuprofen best painkiller for kids. L. Tanner. Jackson [WY] News Tribune. 3/5/07.

Deciding which medicine to give a child in pain just got easier: The first head-to-head study of three common painkillers found that ibuprofen works best, at least for kids with broken bones, bruises and sprains. For parents, choosing a painkiller for kids can be confusing, partly because acetaminophen, sold as Tylenol, and ibuprofen both work against fevers. Codeine does too, but it’s a mild narcotic available only by prescription. Studies comparing ibuprofen with acetaminophen for pain relief have had conflicting results, but Clark said his is the first to compare all three drugs. Ibuprofen may work better for pain from trauma because it targets inflammation while acetaminophen and codeine do not.

Overview of New Neuroleptic – Invega. Dan Egli

A quick overview of Paliperidone (Invega®); atypical neuroleptic #7 of 7. This supposed new atypical neuroleptic (in my opinion) is: just 9-OH risperidone, the release technology (similar to but different from Concerta’s) conveys no clinical advantages, just a patent extender for risperidone.

The MADISON Scale – Ed Zuckerman.

The smart psychiatrist Thomas Hackett discussed coping with somatizing patients. Clues to the diagnosis of psychologically mediated pain disorder include 1) h/o poor premorbid life adjustment (alcohol abuse, multiple marriages, inability to hold a job, etc). 2) temporal relation to possible triggering stimulus; 3) utility of pain for getting benefits or avoiding work or undesirable situations. 4) lack of variation in the amount of pain undervarious conditions. The Madison scale has not been validated, but is frequencly used to identify emotional overlay:

MADISON scale for emotional overlay in pain.
M - Multiplicity. Pain present in many locations.
A - Authenticity: more interested physician’s accepting pain than finding a cure.
D - Denial: exaggerated description of family or personal well-being.
I - Interpersonal relationships.
S - Singularity : pain described as unlike pain of anyone else.
O - “ Only you”: other physicians have failed, but you are/will be the savior.
N - Nothing helps, no change: no medications help pain, and there is no variation from hour to hour or day to day.

Management: Accurate diagnosis and focus on functional status are key. During visits acknowledge pain but focus on function. Many modalities used: NSAID’s, tricyclics (one study suggests that these are more effective if combined with group therapy); SSRI’s, nerve blocks, physical therapy, relaxation, visual imaging, hypnosis, cognitive behavioral therapy, supportive therapy.

Exercises Stave Off Declines of Aging. Washington Post. 12/19/06.

Ten sessions of exercises to boost reasoning skills, memory and mental processing speed staved off mental decline in middle-aged and elderly people in the first definitive study to show that honing intellectual skills can bolster the mind in the same way that physical exercise protects and strengthens the body. The researchers also showed that the benefits of the brain exercises extended well beyond the specific skills the volunteers learned. Older adults who did the basic exercises followed by later sessions were three times as fast as those who got only the initial sessions when it came to activities of daily living, such as reacting to a road sign, looking up a number in a telephone book or checking the ingredients on a medicine bottle -- abilities that can spell the difference between living independently and needing help.
(Thanks to Robert Griffin for forwarding this article)