Background: Anxiety is characterized by hypervigilance, distractibility and selective processing of negative information. There is growing evidence that prefrontal function underlies biases in threat processing and attention control in anxiety. We examined the effect of 20 min of 2 mA dorsolateral prefrontal cortex transcranial direct current stimulation (tDCS) (bipolar-balanced montage) on subjective anxiety, autonomic arousal and threat processing in the 7.5% CO2 experimental medicine model of anxiety.Methods: A between-subjects healthy volunteer double-blind randomized design compared 2 mA tDCS stimulation of the PFC versus sham tDCS on subjective anxiety, autonomic arousal and antisaccade performance during 7.5% CO2 challenge.Results: tDCS did not moderate subjective and autonomic response to CO2 challenge. tDCS reduced erroneous eye movements toward threat images relative to neutral images.Conclusion: Twenty minutes of active 2 mA tDCS over the left dorsolateral prefrontal cortex may reduce threat processing biases during experimentally induced anxiety and could help target early positive changes in emotion processing.

BACKGROUND:Transcranial direct current stimulation (tDCS) is a non-invasive form of neurostimulation with potential for development as a self-administered intervention. It has shown promise as a safe and effective treatment for obsessive compulsive disorder (OCD) in a small number of studies. The two most favourable stimulation targets appear to be the left orbitofrontal cortex (L-OFC) and the supplementary motor area (SMA). We report the first study to test these targets head-to-head within a randomised sham-controlled trial. Our aim was to inform the design of future clinical research studies, by focussing on the acceptability and safety of the intervention, feasibility of recruitment, adherence to and tolerability of tDCS, and the size of any treatment-effect.METHODS:FEATSOCS was a randomised, double-blind, sham-controlled, cross-over, multicentre study. Twenty adults with DSM-5-defined OCD were randomised to treatment, comprising three courses of clinic-based tDCS (SMA, L-OFC, Sham), randomly allocated and delivered in counterbalanced order. Each course comprised four 20-min 2 mA stimulations, delivered over two consecutive days, separated by a 'washout' period of at least four weeks. Assessments were carried out by raters who were blind to stimulation-type. Clinical outcomes were assessed before, during, and up to four weeks after stimulation. Patient representatives with lived experience of OCD were actively involved at all stages.RESULTS:Clinicians showed willingness to recruit participants and recruitment to target was achieved. Adherence to treatment and study interventions was generally good, with only two dropouts. There were no serious adverse events, and adverse effects which did occur were transient and mostly mild in intensity. Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores were numerically improved from baseline to 24 h after the final stimulation across all intervention groups but tended to worsen thereafter. The greatest effect size was seen in the L-OFC arm, (Cohen's d = -0.5 [95% CI -1.2 to 0.2] versus Sham), suggesting this stimulation site should be pursued in further studies. Additional significant sham referenced improvements in secondary outcomes occurred in the L-OFC arm, and to a lesser extent with SMA stimulation.CONCLUSIONS:tDCS was acceptable, practicable to apply, well-tolerated and appears a promising potential treatment for OCD. The L-OFC represents the most promising target based on clinical changes, though the effects on OCD symptoms were not statistically significant compared to sham. SMA stimulation showed lesser signs of promise. Further investigation of tDCS in OCD is warranted, to determine the optimal stimulation protocol (current, frequency, duration), longer-term effectiveness and brain-based mechanisms of effect. If efficacy is substantiated, consideration of home-based approaches represents a rational next step.TRIAL REGISTRATION:ISRCTN17937049. https://doi.org/10.1186/ISRCTN17937049.

<h3>Background</h3> Hepatitis B virus (HBV) is a global health problem with an estimated 200,000 individuals with chronic HBV in the UK, 95% of which are in immigrant populations. The goal of elimination by 2030 is challenging even in the UK partly because HBV is commoner in deprived areas, and a failure in investigation and referral pathways. In the NHS in England the ‘Core20Plus5’ programme provides a mandate for tackling inequalities. ‘Core20’ refers to individuals in the 20% most deprived areas defined by the Index of Multiple Deprivation (IMD deciles 1 &2). We tested the hypothesis that our novel case-finding database developed in Somerset (covering 0.6m population) could identify HBV infected patients and provide a means to target those in deprived areas. <h3>Methods</h3> We configured our case-finding database to identify adult patients with HBV infection (positive HBV surface antigen). Within the tool, searches were stratified by IMD decile. Patients electronic patient records were reviewed to categorise as follows: 1) no data, 2) out of the area, 3) never referred, 4) never engaged following referral, 5) lost to follow-up (patient disengagement or system issues) and 6) actively followed or treated (chronic HBV or followed to surface antigen loss). Individuals in deprived areas data (IMD deciles 1 & 2) were compared to control (IMD 3 – 10). <h3>Results</h3> Correcting for the known lower immigrant population we predicted 900 chronic HBV patients in Somerset (estimated 0.45% prevalence within the UK). The case finding database identified 302 HBV+ve patients. A deprivation score was available for 98.8% of the population. 9% of the whole Somerset population came from deprived areas compared to 24% of men and 12% of women with HBV (P<10–5). Overall, 38% of patients with HBV were either not referred, didn’t engage or subsequently lost to follow-up, and 97 patients were identified for further investigation/recall. There was a trend towards worse treatment rates in IMD 1 & 2 with 48% men and 47% women not appropriately engaged. <h3>Conclusion</h3> HBV continues to be underdiagnosed with only 1/3 of expected patients identified in Somerset. This is likely to be multifactorial, including lack of screening of patients with abnormal LFTs and other risk factors. HBV is more common in deprived areas and our case finding database will now be used to target patients for treatment. In addition, it will be used to target individuals with persistently abnormal LFTs not previously tested for HBV.

AimsObsessive Compulsive Disorder is a disabling and difficult-to-treat condition, new treatment options are needed to improve health outcomes. Transcranial Direct Current Stimulation, a non-invasive form of neurostimulation, has shown positive results in a small number of studies as a safe and potentially efficacious treatment for OCD. There nevertheless remains uncertainty about the optimal stimulation protocol, magnitude and duration of effect, acceptability, tolerability and practicality of applying tDCS clinical settings. As existing data are inadequate to support a full-scale trial, we will deliver a feasibility study to address key research questions and knowledge gaps to enable the design and the development of the most efficient, cost effective, definitive trial.MethodWe designed Feasibility And Acceptability Of Transcranial Stimulation In Obsessive Compulsive Symptoms (FEATSOCS), a double-blind, sham-controlled, cross-over randomised multicentre study in 25 adults with OCD. We will stimulate the two most promising cortical sites, the orbitofrontal cortex (OFC) and the supplementary motor area (SMA). Each participant will receive three courses of tDCS (SMA, OFC and sham), randomly allocated, given in counterbalanced order. Each course comprises four 20 minutes-stimulations, delivered over two consecutive days, separated by at least four weeks’ washout period. Blinded raters will regularly assess clinical outcomes before, during and up to four weeks after stimulation using validated scales. We will include relevant neurocognitive tasks, testing cognitive flexibility, motor disinhibition, cooperation and habit learning.ResultFEATSOCS trial is currently underway and recruiting. Owing to the impact of COVID-19, a recruitment extension has been granted. At the study end, we will analyse the feasibility outcomes, magnitude of the effect of the interventions on OCD symptoms alongside the standard deviation of the outcome measure to estimate effect size, and determine the optimal stimulation target. We will also measure the duration of the effect of stimulation, to provide information on spacing treatments efficiently. We will evaluate the usefulness and limitations of specific neurocognitive tests to determine a definitive test battery. Qualitative data will be collected from participants to better understand their experience of taking part in a tDCS intervention, the impact on their overall quality of life and their views on the potential of tDCS as home based-intervention.ConclusionFurther evidence is needed to establish whether tDCS could join the treatment armamentarium of OCD. The clinical outcomes in FEATSOCS will enable to further refine the methodology to ensure optimal efficiency in terms of both delivering and assessing the tDCS in OCD in a full scale trial.The funder for this study is the National Institute for Health Research Programme, Research for Patient Benefit (RfPB) [Ref. no PB-PG-1216-20005]. Extra funding to allow study extension was provided by Orchard OCD. This study has received full ethics committee approval and protocol amendments approval form the Cambridge and Hertfordshire NHS Research Ethics Committee, IRAS Project ID 254507, REC ref: 19/EE/0046.

Abstract Background Obsessive–compulsive disorder (OCD) is a neuropsychiatric disorder which often proves refractory to current treatment approaches. Transcranial direct current stimulation (tDCS), a noninvasive form of neurostimulation, with potential for development as a self-administered intervention, has shown potential as a safe and efficacious treatment for OCD in a small number of trials. The two most promising stimulation sites are located above the orbitofrontal cortex (OFC) and the supplementary motor area (SMA). Methods The aim of this feasibility study is to inform the development of a definitive trial, focussing on the acceptability, safety of the intervention, feasibility of recruitment, adherence and tolerability to tDCS and study assessments and the size of the treatment effect. To this end, we will deliver a double-blind, sham-controlled, crossover randomised multicentre study in 25 adults with OCD. Each participant will receive three courses of tDCS (SMA, OFC and sham), randomly allocated and given in counterbalanced order. Each course comprises four 20-min stimulations, delivered over two consecutive days, separated by at least 4 weeks’ washout period. We will collect information about recruitment, study conduct and tDCS delivery. Blinded raters will assess clinical outcomes before, during and up to 4 weeks after stimulation using validated scales. We will include relevant objective neurocognitive tasks, testing cognitive flexibility, motor disinhibition, cooperation and habit learning. Discussion We will analyse the magnitude of the effect of the interventions on OCD symptoms alongside the standard deviation of the outcome measure, to estimate effect size and determine the optimal stimulation target. We will also measure the duration of the effect of stimulation, to provide information on spacing treatments efficiently. We will evaluate the usefulness and limitations of specific neurocognitive tests to determine a definitive test battery. Additionally, qualitative data will be collected from participants to better understand their experience of taking part in a tDCS intervention, as well as the impact on their overall quality of life. These clinical outcomes will enable the project team to further refine the methodology to ensure optimal efficiency in terms of both delivering and assessing the treatment in a full-scale trial. Trial registration ISRCTN17937049. (date applied 08/07/2019). Recruitment (ongoing) began 23rd July 2019 and is anticipated to complete 30th April 2021.

Bipolar DisordersVolume 20, Issue 3 p. 289-292 CLINICAL CARE Assessment and management of bipolar disorder: Principal summary of updated Chinese guidelines Zuowei Wang, Zuowei Wang orcid.org/0000-0002-1929-231X Division of Mood Disorders, Hongkou District Mental Health Center of Shanghai, Shanghai, ChinaSearch for more papers by this authorJun Chen, Jun Chen Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaSearch for more papers by this authorHaichen Yang, Haichen Yang Department of Mood Disorders, Shenzhen Mental Health Centre, Guangdong, ChinaSearch for more papers by this authorYantao Ma, Yantao Ma Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, ChinaSearch for more papers by this authorDaniel Meron, Daniel Meron Clinical and Experimental Sciences Academic Unit (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UKSearch for more papers by this authorTiebang Liu, Tiebang Liu Department of Mood Disorders, Shenzhen Mental Health Centre, Guangdong, ChinaSearch for more papers by this authorXin Yu, Corresponding Author Xin Yu yuxin@bjmu.edu.cn Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China Correspondence Xin Yu, Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China; or Yiru Fang, Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Email: yuxin@bjmu.edu.cn; yirufang@aliyun.comSearch for more papers by this authorYiru Fang, Corresponding Author Yiru Fang yirufang@aliyun.com Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai, China Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China Correspondence Xin Yu, Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China; or Yiru Fang, Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Email: yuxin@bjmu.edu.cn; yirufang@aliyun.comSearch for more papers by this author Zuowei Wang, Zuowei Wang orcid.org/0000-0002-1929-231X Division of Mood Disorders, Hongkou District Mental Health Center of Shanghai, Shanghai, ChinaSearch for more papers by this authorJun Chen, Jun Chen Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaSearch for more papers by this authorHaichen Yang, Haichen Yang Department of Mood Disorders, Shenzhen Mental Health Centre, Guangdong, ChinaSearch for more papers by this authorYantao Ma, Yantao Ma Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, ChinaSearch for more papers by this authorDaniel Meron, Daniel Meron Clinical and Experimental Sciences Academic Unit (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UKSearch for more papers by this authorTiebang Liu, Tiebang Liu Department of Mood Disorders, Shenzhen Mental Health Centre, Guangdong, ChinaSearch for more papers by this authorXin Yu, Corresponding Author Xin Yu yuxin@bjmu.edu.cn Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China Correspondence Xin Yu, Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China; or Yiru Fang, Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Email: yuxin@bjmu.edu.cn; yirufang@aliyun.comSearch for more papers by this authorYiru Fang, Corresponding Author Yiru Fang yirufang@aliyun.com Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai, China Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China Correspondence Xin Yu, Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China; or Yiru Fang, Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Email: yuxin@bjmu.edu.cn; yirufang@aliyun.comSearch for more papers by this author First published: 31 March 2018 https://doi.org/10.1111/bdi.12646Citations: 4Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume20, Issue3May 2018Pages 289-292 RelatedInformation

ObjectivesThe effect of acute transcranial direct current stimulation (tDCS) on cortical attention networks remains unclear. We examined the effect of 20 min of 2 mA dorsolateral prefrontal cortex tDCS (bipolar balanced montage) on the efficiency of alerting, orienting and executive attention networks measured by the attention network test. Materials and MethodsA between-subjects stratified randomized design compared active tDCS vs. sham tDCS on attention network function in healthy young adults. ResultsExecutive attention was greater following active vs. sham stimulation (d=0.76) in the absence of effects on alerting, orienting, or global RT or error rates. Group differences were not moderated by state-mood. Conclusion(s)Twenty minutes of active 2 mA tDCS over left DLPFC is associated with greater executive attention in healthy humans.

Inhalation of 7.5% carbon dioxide increases anxiety and autonomic arousal and provides a novel experimental model of anxiety with which to evaluate pharmacological and psychological treatments for anxiety. To date several psychotropic drugs including benzodiazepines, SSRIs and SNRIs have been evaluated using the 7.5% CO2 model; however, it has yet to be used to evaluate psychological interventions. We compared the effects of two core psychological components of mindfulness-meditation (open monitoring and focused attention) against general relaxation, on subjective, autonomic and neuropsychological outcomes in the 7.5% CO2 experimental model. 32 healthy screened adults were randomized to complete 10 min of guided open monitoring, focused attention or relaxation, immediately before inhaling 7.5% CO2 for 20 min. During CO2-challenge participants completed an eye-tracking measure of attention control and selective attention. Measures of subjective anxiety, blood pressure and heart rate were taken at baseline and immediately following intervention and CO2-challenge. OM and FA practice reduced subjective feelings of anxiety during 20-min inhalation of 7.5% CO2 compared to relaxation control. OM practice produced a strong anxiolytic effect, whereas the effect of FA was more modest. Anxiolytic OM and FA effects occurred in the absence of group differences in autonomic arousal and eye-movement measures of attention. Our findings are consistent with neuropsychological models of mindfulness-meditation that propose OM and FA activate prefrontal mechanisms that support emotion regulation during periods of anxiety and physiological hyper-arousal. Our findings complement those from pharmacological treatment studies, further supporting the use of CO2 challenge to evaluate future therapeutic interventions for anxiety.

•We identified 10 RCTs (N=393) of tDCS as treatment for MDE.•tDCS was superior to sham tDCS (k=11, g=0.30, 95% CI=[0.04, 0.57], p=0.027).•N=346 to detect (80% power) this effect (N=49/N=12693 for bounds of CI).•Current data do not support the use of tDCS in treatment resistant depression.•Larger studies over longer periods of treatment are needed.

Bipolar depression (BD) is a highly prevalent condition associated with marked cognitive deficits that persist even in the euthymic phase of the illness. Pharmacological treatments for BD might further aggravate cognitive impairment, highlighting the need of developing interventions that present cognitive safety. In this study, we evaluated the cognitive effects of H1-coil (deep) transcranial magnetic stimulation (TMS) in patients with treatment-resistant bipolar depression.Fourty-three patients were randomized to receive 20 sessions of active (55 trains, 18 Hz, 120% resting motor threshold intensity) or sham rTMS within a double-blind, sham-controlled trial. A battery of 20 neuropsychological assessments, grouped in 6 domains (attention and processing speed, working memory and executive function, inhibitory control, language, immediate verbal memory, and long-term verbal memory) was performed at baseline and after 4 and 8 weeks of trial onset. Depressive symptoms were assessed with the 17-item Hamilton Rating Scale for Depression.Cognitive improvement was shown for all cognitive domains. It occurred regardless of intervention group and depression improvement. For the language domain, greater improvement was observed in the sham group over time. No correlations between depression (at baseline or during treatment) and cognitive improvement were found.Absence of healthy control group.The results of this exploratory study provide evidence on the cognitive safety of H1-coil TMS for BD patients. Putative pro-cognitive effects of rTMS in BD were not observed and thus should be further investigated.

NC). Linkage disequilibrium (LD) and Hardy–Weinberg equilibrium (HW) were analyzed using Haploview4.2. Statistical tests were performed using ‘R’ software. For single SNPs association with resistance or response were performed using Fisher’s exact test. Haplotypes were analyzed via the Haplo.Stats package for ‘R’ using haplo.em, haplo.score and haplo.score.slide. Results were corrected for multiple testings. Results: All SNPs were in HD, and LD was detected for rs4777989 and rs8035760 and for rs11853992 and 17522085. The Fisher test for resistance vs. nonresistance did not show significant effects. The Fisher test investigating response vs. nonresponse showed associations of the C allele of rs3784723 (p = 0.01) and of the G-allele of rs4777989 (p = 0.04) with treatment response. An association of rs2290492 did not withstand correction for multiple testings. For haplotype analysis sliding windows of 3 SNPs were used, showing significant global p values for haplotypes starting at SNP 1, 2 and 3. We therefore used SNP 1−5 (rs2290492, rs3759917, rs3784723, rs4777989, rs8035760) comprised in these windows for haplotype association. The haplotype C-T-C-G-A was associated with treatment response (p = 0.04), in accordance to the single marker association tests. Conclusion: This is the first study investigating genetic polymorphisms within ST8SIA2 in treatment resistant depression and treatment response. It further affirms the proposed role of ST8SIA2 in the serotonergic system and depression. Our results point toward an impact of a haplotype comprising 4 SNPs on response to various antidepressants. Two of these SNPs also showed effects in single marker association tests. Thus our study elaborates the connection of ST8SIA2 to MDD and the serotonergic system and provides new data on genetics in treatment response.

Mindfulness meditation techniques are increasingly popular both as a life-style choice and therapeutic adjunct for a range of mental and physical health conditions. However, little is known about the mechanisms through which mindfulness meditation and its constituent practices might produce positive change in cognition and emotion. Our study directly compared the effects of Focused Attention (FA) and Open-Monitoring (OM) meditation on alerting, orienting and executive attention network function in healthy individuals. Participants were randomized to three intervention groups: open-focused meditation, focused attention, and relaxation control. Participants completed an emotional variant of the Attention Network Test (ANT) at baseline and post-intervention. OM and FA practice improved executive attention, with no change observed in the relaxation control group. Improvements in executive attention occurred in the absence of change in subjective/self-report mood and cognitive function. Baseline levels of dispositional/trait mindfulness were positively correlated with executive control in the ANT at baseline. Our results suggest that mindfulness meditation might usefully target deficits in executive attention that characterise mood and anxiety disorders.

Debate continues regarding whether humanitarian values such as care and compassion can be taught or are innate in individuals who wish to become nurses.To undertake a discursive review of the literature on caring, compassion and empathy. To understand the teaching and learning issues associated with these concepts. To design and implement an Undergraduate Unit of study which addresses the development of caring, compassion and empathy in student nurses.MEDLINE, CINAHL, and a wide range of literature including books and governmental reports were used for a discursive narrative review.Caring, compassion and empathy are ill-defined; however healthcare users are clear that they know when nurses use skills and attitudes associated with these concepts. Evidence is available to show that caring, compassion and empathy can be taught and there are tools available to measure them in neophytes through their training. Central to the androgogical embedding of these concepts into nursing curricula is the development of therapeutic relationships.It is possible to develop materials to enable student nurses to learn how to care using compassion and empathy. Nursing therapeutics is a term devised to describe how student nurses can exploit the therapeutic potential of any patient contact especially when related to specific and routine nursing interventions. Muetzel's model for understanding therapeutic relationships is one framework that can be adopted to help student nurses to appreciate how to build patient relationships and encourage them to move towards therapeutic advantage using care, compassion and empathy.

The ideal anxiolytic drug would be effective in all anxiety disorders, with a rapid onset of action, across all symptom domains and the spectrum of severity, in achieving remission and minimising disability, in preventing relapse, and in treating comorbid depression. Ideally, the drug would be suitable for once-daily dosage, would have minimal adverse effects or cause minimal interference with everyday life, not lead to the development of tolerance, have no discontinuation symptoms, be suitable in physically ill patients and free from interactions, and be safe in overdose.But there are no ideal anxiolytic drugs. Response rates to initial treatment can be disappointing, it is not possible to reliably predict likelihood of response; a substantial proportion of patients experience unwanted effects; many will relapse despite treatment adherence; comparatively little is known about further management after initial non-response; and discontinuation symptoms can be troublesome.Hence there is much room for improvement in identifying those patients who are most likely to benefit from treatment; in choosing between drug and psychological treatments; in choosing the right drug for the right patient groups; in optimising medication dosage to achieve maximum effectiveness whilst minimising adverse effects; in combining drug treatments to enhance efficacy; and in treating over the long term to prevent relapse and recurrence.

Both obsessive-compulsive disorder (OCD) and social phobia are common in community and clinical settings, and it should be expected that a proportion of patients with one of these conditions will also fulfill either current or lifetime criteria for the other condition. However, comorbid social phobia is more common among patients with a primary diagnosis of OCD than is comorbid OCD in patients with a primary diagnosis of social phobia. This article explores the extent of the association of OCD and social phobia in epidemiological studies, and examines the possible role of underlying depression and other disorders in mediating the appearance of the comorbid condition. Although there have been no published randomized controlled trials in patients with this particular pattern of co-morbidity, it seems sensible to adopt pharmacologic and psychologic treatment approaches which have been found efficacious in both OCD and social phobia. Pharmacologic management therefore centers on first-line treatment with a selective serotonin reuptake inhibitor. Psychologic intervention should draw on the range of cognitive and behavioral approaches required for optimal outcomes in OCD and social phobia, as discrete conditions.

Objective: To investigate the effect of mindfulness training on pain tolerance, psychological well-being, physiological activity, and the acquisition of mindfulness skills. Methods: Forty-two asymptomatic University students participated in a randomized, single-blind, active control pilot study. Participants in the experimental condition were offered six (1-h) mindfulness sessions; control participants were offered two (1-h) Guided Visual Imagery sessions. Both groups were provided with practice CDs and encouraged to practice daily. Pre-post pain tolerance (cold pressor test), mood, blood pressure, pulse, and mindfulness skills were obtained. Results: Pain tolerance significantly increased in the mindfulness condition only. There was a strong trend indicating that mindfulness skills increased in the mindfulness condition, but this was not related to improved pain tolerance. Diastolic blood pressure significantly decreased in both conditions. Conclusion: Mindfulness training did increase pain tolerance, but this was not related to the acquisition of mindfulness skills. (c) 2007 Elsevier Inc. All rights reserved.