Sustained attention and visual processing speed in children and adolescents with bipolar disorder and other psychiatric disorders

To investigate the cognitive functioning of children and adolescents with bipolar illness, 112 child and adolescent psychiatric inpatients and day-hospital patients at a state psychiatric hospital were administered the Wechsler Intelligence Scale for Children-III (WISC-III) as part of an admission psychological assessment. There were 22 patients with Bipolar Disorder and 90 with other psychiatric disorders; all were between 8 and 17 years of age. The patients with Bipolar Disorder had a mean age of 14 yr., a mean Verbal IQ of 78, a mean Performance IQ of 76, and a mean Full Scale IQ of 75. When their WISC-III scores were compared with those who had Schizophrenia Spectrum disorders (Schizophrenia and Schizoaffective Disorder), Psychosis Not Otherwise Specified, Attention Deficit Hyperactivity Disorder, and Conduct Disorder and Oppositional Defiant Disorder, there were no significant between-group mean differences for Verbal IQ, but patients with Bipolar Disorder had a significantly lower mean Performance IQ than those with ADHD and those with Conduct Disorder and Oppositional Defiant Disorder. Contrary to the expectation that the patients with Bipolar Disorder might have better sustained attention (higher Digit Span scores) than those with Schizophrenia Spectrum disorders and worse visual processing speed (lower Coding scores) than the other diagnostic groups, the bipolar patients' Digit Span and Coding scores did not differ significantly from those of the other groups. The patients with Psychosis, Not Otherwise Specified had significantly lower mean Performance IQ, Full Scale IQ, and Coding than the ADHD and the Conduct Disorder and Oppositional Disorder groups.     

The categorization of thought disorder

We describe the development of a new system for categorizing thought disorder. In the development phase (Study 1), we examined the degree to which speech samples and definitions of thought disorder subtypes taken from: (1) the Scale for the Assessment of Thought, Language, and Communication (TLC); (2) the Though Disorder Index (TDI); and (3) the Assessment of Bizarre-Idiosyncratic Thinking (BIT), reflected disturbances in form versus disturbances in content. Ratings were provided by naive judges, experienced clinicians, and linguistic experts. The results contributed to the development of a new system dividing thought disorder into disturbances in (1) fluency, (2) discourse coherence, (3) content, and (4) social convention. In the validation phase (Study 2), 21 schizophrenic and 19 manic subjects were interviewed, interpreted proverbs, and responded to Rorschach cards. Subjects' speech was rated using the TLC, TDI, and BIT. We also measured hallucinations, delusions, and digit span performance. The results of Study 2 provided evidence supporting the validity of our new categorization system.     

A comparison of behavioral and emotional functioning in children and adolescents with Autistic Disorder and PDD-NOS.

Behavioral symptomatology was compared in 26 children and adolescents with Autistic Disorder ("autism") and 25 children and adolescents with Pervasive Developmental Disorder, Not Otherwise Specified ("PDD-NOS"). Relative to individuals with PDD-NOS, those with autism had more symptoms of depression, social withdrawal, atypical behavior, and immature social skills--and fewer family problems. These differences remained even when group differences in intellectual ability were statistically controlled. No group differences emerged in somatization, anxiety, or hyperactivity. Findings suggest that although both groups demonstrate considerable evidence of behavioral and emotional problems, those with autism are at particularly high risk for comorbid behavioral and emotional disabilities.     

Co-occurrence of non-suicidal self-injury and impulsivity in extreme weight conditions

The aims of the present study were to determine the prevalence of non-suicidal self-injury (NSSI) in different eating disorder (ED) groups and morbid obesity, and to investigate whether NSSI in different ED/obesity groups co-occur with impulsivity. We assessed 535 individuals (365 ED and 170 obese patients) by means of a single item assessing lifetime NSSI and the Barratt Impulsivity Scale, which measures different dimensions of impulsivity. The results showed that 19.1% of the ED patients engaged in at least one act of NSSI during their life-time. NSSI was more prevalent in Bulimia Nervosa, Binge Eating Disorder, Eating Disorder Not Otherwise Specified compared to Anorexia Nervosa, Restrictive type and morbid obesity. Finally, ED/obese patients who engaged in NSSI scored significantly higher on the attentional, motor and non-planning subscales than patients without NSSI. The implications of these findings for the treatment of NSSI in binge/purging ED patients are discussed.     

A comparison between the Grid Test of Schizophrenic Thought Disorder and diagnostic psychologicaI testing

Abstract.— Bannister and Fransella's Grid Test of Schizophrenic Thought Disorder based on Personal Construct Theory and the concept of "loosened construing", as measurable in the scores of Intensity and Consistency between intercorrelations, has been applied to a Scandinavian sample of psychiatric patients. The validity of the test was illustrated, and a significant difference was found between a group of schizophrenics and schizophrenic borderline states and a group without schizophrenic thought disorders. The Grid Test scores were found to agree with thought disorder manifestations as evaluated in qualitative terms on the basis of cognitive and projective tests, but they did not differentiate between developmental levels of thinking corresponding to con-creteness in organic impairment versus diffuseness in schizophrenia. Thus, the concept of "loosened construing" as applied in this thought disorder test seems too unspecific.     

Day-Hospital Multifocal Integrated Treatment for Anorexia Nervosa in Adolescents: A One-Year Follow-Up

The current guidelines for treatment of Anorexia Nervosa (AN) in children and adolescents recommend an integrated multidisciplinary approach as the elective intervention for this disorder. Nevertheless, there is insufficient evidence on the results of an integrated approach for the treatment of AN adolescent patients, especially in a Hospital setting. This study aims to analyze clinical and psychological changes occurring in adolescent patients after completion of a Day-Hospital Multifocal Integrated Treatment (MIT) for Anorexia Nervosa. The sample consisted of 60 adolescents with AN or Eating Disorder Not Otherwise Specified (EDNOS) restrictive type, aged 11 to 18 years, and their parents. Clinical course was evaluated at 3, 6 and 12-month follow-up periods. Our results showed clinical remission in a good percentage of patients. In general, we found a significant reduction of the eating psychopathology, whereas we did not detect any significant improvement in body dissatisfaction, perfectionism, and relational difficulties. This positive trend was confirmed at 3, 6, and 12-month follow-up, despite the increase of drop-outs. These results suggest that the proposed treatment is reasonably effective, because it aims to contain and reduce the acute phase of the disease in a limited time and in a hospital setting, but it is necessary to continue the treatment with targeted psychotherapeutic interventions to address the deeper psychological discomfort underlying the eating disorder.     

Communication deviance in families of schizophrenic and manic patients

Levels of communication deviance (CD) distinguish parents of schizophrenic patients from parents of nonpsychotic patients, but the prevalence of intrafamilial CD in other psychotic disorders has not been examined. Levels of CD were compared across biological parents of schizophrenic (n = 39) and bipolar manic (n = 16) patients and across patients themselves. CD ratings were based on Thematic Apperception Test protocols (parents only) and family interactions (parents and patients). Total levels of CD did not distinguish between groups of parents or patients. However, instances of odd word usage were more frequent among parents of manic patients than among parents of schizophrenic patients on both CD measures. Also, during the interaction task, odd word usage was more frequent among manic patients, whereas schizophrenic patients made more ambiguous references. Results suggest that high levels of intrafamilial CD are not unique to schizophrenia.     

The relations of thematic and nonthematic childhood depression measures to defensiveness and gender

The susceptibility of self-report and thematic measures of depression to the effects of a defensive test-taking approach was assessed among 44 child and adolescent psychiatric inpatients. It was hypothesized that scores on a measure of defensiveness would be associated with self-reported but not thematic measures of depression, and furthermore, that this finding would be more pronounced for girls than boys. Patients completed the Lie Scale of the Revised Children's Manifest Anxiety Scale (RCMAS), the Children's Depression Inventory (CDI), and the Roberts Apperception Test for Children. As predicted, RCMAS-Lie scores were significantly associated with CDI but not Roberts Depression scores, and this effect was more pronounced among females, primarily due to the high CDI scores of nondefensive girls. Implications of results for psychological assessment of children and adolescents are discussed.     

Mental health problems and post-migration stress among multi-traumatized refugees attending outpatient clinics upon resettlement to Norway

Refugees have often been exposed to multiple traumas making them prone to mental health problems later. The aim of this study is to describe the prevalence and symptom load of psychiatric disorders in refugees admitted to psychiatric outpatient clinics and to investigate the relationship between multiple exposure to traumatic events, the severity of traumatic symptoms and post-migration stressors. A clinical sample of 61 refugee outpatients from psychiatric clinics in Southern Norway was cross-sectionally examined using three structured clinical interviews (SCID-PTSD, SIDES and MINI) and self-report psychometric instruments (HSCL-25, IES-R). Post-traumatic Stress Disorder (PTSD) was diagnosed in 82% of the patients, while Disorders of Extreme Stress Not Otherwise Specified (DESNOS) was present in 16% of them. Comorbidity was considerable; 64% of the patients had both PTSD and major depression disorder (MDD) and 80% of those who had PTSD had three or more additional diagnoses. Multi-traumatized refugees in outpatient clinics have high prevalence of PTSD, DESNOS, comorbid depression and anxiety disorders. A more severe symptomatology was found in patients diagnosed with both PTSD and DESNOS, than in those diagnosed with only PTSD. Higher rates of unemployment, weak social network and weak social integration were also prevalent in these outpatients, and related to increased psychiatric comorbidity and severity of symptoms. Further research may clarify the existence of a cumulative relationship between pre-resettlement traumas and post-resettlement stressors in the mental health of refugees, which in turn may help to improve therapeutic interventions.     

The assessment of the social cognition and object relations scale on TAT and interview data

This study examines the reliability and convergent validity of 2 versions of the Social Cognition and Object Relations Scale (SCORS), one for use with Thematic Apperception Test narratives (SCORS-TAT; Westen, 1990) and one for use with clinical interview data (SCORS-CDI; Westen, Barends, Leigh, Mendel, & Silbert, 1990 ). Four SCORS dimensions were evaluated. Data were collected in a psychiatric sample (N = 74). Results show that although interrater reliability was good for all dimensions, internal consistency was low, especially for the affective dimensions. Structural equation modeling, in which a model with 2 factors (i.e., SCORS-TAT and SCORS-CDI) and 4 dimensions each was tested, indicated low convergence between corresponding dimensions of SCORS-TAT and SCORS-CDI. Correlational analyses suggested that this was due to a strong method factor. Regression analyses, however, revealed that the presence of a personality disorder operated as a moderator for convergence between corresponding cognitive-structural dimensions.     

Self-Reported Attachment Patterns and Rorschach-Related Scores of Ego Boundary,Defensive Processes,and Thinking Disorders

An Associative Elaboration Scale and an Integration Scale were constructed for evaluating Thematic Apperception Test (TAT) protocols. Interrater reliabilities and the correlation between the two scales were determined for a selection of TAT cards. The Integration Scale was dropped from further analyses, because its interrater reliabilities were low and it correlated highly with the Associative Elaboration Scale. The relation between the Associative Elaboration Scale and age was then investigated for randomly selected patients aged 7, 9, 11, 13, and 15. There tended to be a rapid increase in Associative Elaboration scores up to age 11 and then little or no increase in scores. There was no significant relation between Associative Elaboration and IQ.     

自闭症谱系障碍者面孔识别的神经机制

自闭症谱系障碍（ASD）是一种心理状况的谱系障碍,其症状是社交及沟通上的广泛性异常、异常局限性的兴趣和高度重复性的刻板行为。包括自闭症、亚斯伯格症候群和待分类的广泛性发展障碍3类。研究主要以事件相关电位和功能性磁共振成像两种技术为线索,通过深入分析ASD患者在面孔识别认知过程中脑的异常变化,探讨其面孔识别障碍的神经机制问题。研究表明,ASD患者面孔识别能力的损伤主要与N170、N300、P400和Nc等ERPs成份异常及梭状回面孔区和杏仁核的低激活有关。研究推论ASD患者面孔识别障碍是多个异常脑区联合作用的结果,且主要受异常脑区的数量和损伤程度的影响。     

Social attitudes of schizophrenics

The Wilson-Patterson Conservatism Scale was given to 34 schizophrenic and 34 non-schizophrenic patients in a Dutch mental hospital. The absence of liberal-scoring schizophrenics was interpreted as consistent with the theory that the social withdrawal seen in chronic schizophrenia represents a strategy for coping with stimulus overload. Internal consistency analysis of C scale performance indicated that this test might be used to assess thought disorder in much the same way as the Bannister and Fransella Grid Test, but a great deal more economically. Furthermore, the questionnaire permits a more detailed examination of the source of inconsistency than does the repertory grid method.     

Parental communication deviance and schizophrenia: a cross-cultural comparison of Mexican- and Anglo-Americans

Levels of parental communication deviance (CD), as measured on the Thematic Apperception Test (TAT), were compared among families of schizophrenic patients in two culturally distinct groups. Spanish-speaking Mexican-American parents of schizophrenics completed the TAT in their native language, and CD was coded from their stories by a Spanish-speaking rater. Mexican-American parents had levels of CD that were nearly identical to those of a carefully matched sample of English-speaking Anglo-American parents. Factor scores that measure distinct subtypes of CD also did not differ across groups. The data suggest that levels of CD, despite discriminating between parents of schizophrenics and nonschizophrenics, do not vary across different languages and cultures.     

Children's internal representations,empathy, and fantasy play: a validity study of the SCORS-Q

The authors investigated relationships among internal representations, empathy, and affective and cognitive processes in fantasy play to test the validity of the Social Cognition and Object Relations Scale Q-Sort (SCORS-Q; D. Westen, 1995) with children. Eighty-six 8-10-year-olds were administered 8 Thematic Apperception Test cards, a standardized play task, and a self-report empathy measure. Teachers rated children's empathy and helpfulness. As predicted, internal representations were related to empathy, helpfulness, and quality of fantasy play. Developmental differences on the SCORS-Q were consistent with object relations theory and with results from the original SCORS. The findings support the value of internal representations as a means of understanding children's interpersonal functioning and contribute to the validity of the SCORS-Q for use with children.     

Autism Spectrum Symptomatology in Children: The Impact of Family and Peer Relationships

This study examines the potential impact of family conflict and cohesion, and peer support/bullying on children with autism spectrum disorder (ASD). While such impacts have been established for a range of non-ASD childhood disorders, these findings may not generalize to children with ASD because of unique problems in perspective-taking, understanding others’ emotion, cognitive rigidity, and social reasoning. A structural model-building approach was used to test the extent to which family and peer variables directly or indirectly affected ASD via child anxiety/depression. The sample (N = 322) consisted of parents of children with ASD referred to two specialist clinics. The sample contained parents of children with Autistic Disorder (n = 76), Asperger Disorder (n = 188), Pervasive Disorder Not Otherwise Specified (n = 21), and children with a non-ASD or no diagnosis (n = 37). Parents completed questionnaires on-line via a secure website. The key findings were that anxiety/depression and ASD symptomatology were significantly related, and family conflict was more predictive of ASD symptomatology than positive family/peer influences. The results point to the utility of expanding interventions to include conflict management for couples, even when conflict and family distress is low. Further research is needed on the potentially different meanings of family cohesion and conflict for children with ASD relative to children without ASD.     

Killing the dead: evolution of melancholic identifications underlying suicide attempts in adolescence

Psychic processes underlying suicidal behaviours during adolescence and their evolution are explored. A longitudinal study was conducted of thirty adolescent patients hospitalised following a suicide attempt. Clinical interviews were used combined with the Rorschach Test and the Thematic Apperception Test (TAT) a few days after the suicide attempt and one year later. Results initially showed common forms of psychic adjustment: melancholic identifications were linked to an excessive dependence on objects. One year later, these forms of psychic adjustment changed: for many adolescents, the melancholic identifications shifted and self-image improved. The emergence of representations of murder fantasies immediately after the suicidal behaviour allowed a possible transformation of violence into symbolisation. A case study illustrates these psychic changes.