Ego development and chronic illness in adolescents

To examine the effects of chronic illness on the psychological growth process known as ego development, scores were compared on the Loevinger Sentence Completion Test for 36 teens (16 boys, 20 girls) with chronic illness and 50 teens (16 boys, 34 girls) without chronic illness. Their ages ranged from 13 to 21 years, with a mean of 17.4 years. Most were Black (37%) or Hispanic (41%) and lived in poor or working-class neighborhoods. When age, sex, and Peabody Picture Vocabulary Test (PPVT) scores were controlled in multiple regression analyses, no direct association between ego development stage and presence of chronic illness, severity of illness, age at onset, or duration of illness was found. Analysis of the chronically ill group alone revealed a significant PPVT X Severity interaction, indicating that ego development in chronically ill teens is lower when illness is more severe and verbal IQ is higher.     

Measuring the effectiveness of psychoeducation on adherence,depression, anxiety and stress among patients with diagnosis of schizophrenia. a control trial

Despite evidence of the impact of depression and stress on attitudes towards medication in general medical pathology regimens, little is known of the effects of depression and stress on attitudes towards medication in schizophrenia. This study explores the effects of a hope-based psychoeducation on attitudes towards medication, depression, anxiety and stress, and predictors of attitudes towards medication. The participants in the study (n = 29) were randomly allocated to either the psychoeducation group or the control group. Results from the psychoeducation group revealed that attitudes towards medication were significantly improved and anxiety was significantly reduced. Given the small sample, which was recruited from among patients of a day mental health centre, findings should be interpreted tentatively. Being longer in pharmacotherapy, having experienced fewer occurrences of hospitalisation, and being less depressed predicted positivity towards medication. Patients in the control group did not exhibit significant change in any of the studied variables. Findings were interpreted in the light of research on stigma and insight into illness, and add modestly to literature arguing for the importance of patients’ retention of hope, empowerment and sense of control over illness. This study proposed that psychoeducation is an appropriate intervention to address a wide range of factors that compound adherence to medication and patients’ symptoms, such as patients’ interpretations of causal models, their sense of hope and control over the illness, and their insight into illness and self-stigma.

     

Coping and financial strain as predictors of mental illness in over‐ indebted individuals in Sweden

This cross‐sectional study examined psychological mechanisms in order to increase knowledge regarding mental illness amongst 561 over‐indebted individuals in Sweden. Differences were explored between individuals with probable clinical depression and/or anxiety and individuals without probable clinical depression and/or anxiety, considering objective measures of the debt, financial strain, coping strategies as well as sociodemographic variables. Furthermore, binary logistic regression analyses were performed in order to construct a model of predictors of mental illness. In order to collect the data, Hospital Anxiety and Depression Scale (HADS), Brief Coping Orientation to Problems Experienced (COPE_, as well as questions formulated by the research team, were used as measures. Prominent results showed that over‐indebted individuals with probable clinical depression and/or anxiety were younger, showed greater levels of financial strain, used adaptive coping strategies to a lesser extent, and maladaptive coping strategies to a greater extent. Additionally, financial strain, use of maladaptive and emotion‐focused coping, age and employment status were significant predictors of mental illness. These results put emphasis on the importance of adaptive coping as well as the psychological exposure of over‐indebted individuals.     

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.     

Relationship orientation, quality of prior relationship, and distress among caregivers of Alzheimer's patients

Communal orientation and closeness of the caregiver-patient relationship were investigated as predictors of distress among caregivers of Alzheimer's patients. Persons high in communal orientation were less depressed than those low in communal orientation. Caregivers reporting a close relationship with the patient before illness onset felt less burdened than those whose relationship had not been close. Communal orientation interacted with closeness when data were analyzed separately for men and women. Among men, being low in communal orientation and having a relatively poor prior relationship were associated with the highest levels of depression, levels that put them at risk for clinical depression. Among women low in communal orientation, higher levels of depression were related to having a close prior relationship with the patient.     

Predictors of treatment attendance and adherence to treatment recommendations among individuals receiving Cognitive Behavioral Therapy for Insomnia

ABSTRACT

Insomnia disorders affect up to 10% of adults and are associated with other health problems and poor quality of life. Cognitive Behavioral Therapy for Insomnia (CBT-I) is an effective treatment; however, its effectiveness is hindered by poor attendance and adherence to treatment recommendations. The present study sought to identify predictors of attendance and adherence in CBT-I. Participants were 108 adults with insomnia disorder. Participants were primarily female (71.3%), middle aged (mean age = 50.5), and Caucasian (92.6%). Demographic variables, physical health problems, Beck Anxiety Inventory, Center for Epidemiologic Studies Depression-Revised scale, and Insomnia Severity Index were used to predict attending three or more sessions and adherence to consistent bedtime and waketime. Higher age was associated with better attendance and less deviation in bed and wake times. Anxiety and depression symptoms were associated with less attendance, and depression was also associated with more deviation in waketimes. To promote better attendance and adherence in treatment, depression or anxiety symptoms should be addressed before or during CBT-I. Identifying and tailoring CBT-I treatments toward the needs of different age groups may also improve attendance and adherence.     

The relationship of three measures of childhood depression to academic underachievement

Clinical features of depression (short attention span, lethargy, poor memory and shortened task persistence) appear to be incompatible with effective learning. This has led several investigators to suggest that depression is a significant cause of academic underachievement. The most adequate test of this hypothesis (Tesiny, Lefkowitz, & Gordon, 1980), however, found only small correlations between depression and academic achievement when neither IQ nor socioeconomic status were controlled. In the present study, three measures of childhood depression (Peer Nomination Inventory for Depression, Children's Depression Inventory, and an ad hoc teacher rating) were correlated with scores from the Peabody Individual Achievement Test and the Stanford Achievement Test. IQ was statistically controlled to provide a direct measure of underachievement and analyses were conducted separately for males, females, and the combined sample in a sample that was homogeneous for socioeconomic status. Although intercorrelations among the variables indicated that the sample was appropriate to test the hypothesis, only a few significant correlations were found. These findings suggest that if depression causes academic underachievement, it is a weak or uncommon effect.     

Wechsler performance IQ deficit in depressed children

The original analysis of data on 100 consecutive school age children referred for evaluation of school difficulties showed no differences in IQ among the children with depression and those without depression. Reanalysis of those data shows that a significant number of the depressed children (but not the nondepressed children) have a 15-IQ point Wechsler Performance IQ deficit. This supports the contention that a major subgroup of depressed individuals have right cerebral-hemisphere dysfunction.     

Child functioning predictors of outcome among boys at risk for psychological disorder

This study examined the success of child functioning measures in predicting child outcome for 97 boys with one parent previously hospitalized for psychiatric illness. The best predictors of adaptive functioning at a 3-year follow-up were IQ and clinician ratings based on parent report. Peer and teacher assessments and clinician ratings from interviews were moderately successful.     

Parent Report of Attention Problems Predicts Later Adaptive Functioning in Children with Brain Tumors

Children with brain tumors are at risk for psychological and behavioral difficulties. This study examined the ability of parent report of attention problems, withdrawal, anxiety, and depression, as well as IQ, to predict later adaptive functioning in 42 children treated for brain tumors. Age at diagnosis, SES, gender, and scores on the Neurological Predictor Scale (NPS) also were examined as predictors. Parent report of attention problems, SES, and NPS were significant predictors of later adaptive functioning across domains. This finding highlights the ability of parent report of attention problems to predict later adaptive functioning in children treated for brain tumors.     

Predictors of Response to Cognitive-Behavioral Therapy for Body Dysmorphic Disorder

Body dysmorphic disorder (BDD) is a common and distressing or impairing preoccupation with a perceived defect in physical appearance. Individuals with BDD engage in time-consuming rituals to check, hide, or “fix” their appearance or alleviate distress. BDD is associated with substantial psychosocial impairment and high rates of depression, hospitalization, and suicidality. Cognitive-behavioral therapy (CBT) is the treatment of choice for BDD, but not everyone benefits. We examined predictors of CBT-related improvement, an important topic that has received very limited investigation. Treatment was delivered in weekly individual sessions over 18–22 weeks. Results indicated that greater motivation/readiness to change (University of Rhode Island Change Assessment Questionnaire), greater treatment expectancy (Treatment Credibility/Expectancy Questionnaire), and better baseline BDD-related insight (Brown Assessment of Beliefs Scale) significantly predicted better CBT response at posttreatment. Baseline BDD symptom severity and depression did not predict outcome, suggesting that even patients with more severe BDD and depressive symptoms can benefit from CBT for BDD. Efforts should be aimed at enhancing readiness to change and confidence in the treatment at treatment onset as well as addressing the poor insight that often characterizes BDD.     

Personality related traits as predictors of music practice: Underlying environmental and genetic influences

Little is known about reasons for individual differences in practice behavior – why do some individuals practice more than others? Here we explore personality related traits such as openness, motivation and flow proneness as well as IQ as potential predictors of music practice. Using a large Swedish twin cohort of more than 10,500 individuals we also estimated genetic and environmental influences underlying such associations. Significant associations with music practice were found for IQ, intrinsic motivation, music flow, and openness. With all predictors in the same model (including sex and age) we could explain about 25% of variance in music practice. However, IQ and intrinsic motivation became non-significant in the full model, with music specific flow being the strongest predictor of music practice. Multivariate genetic modeling with the two remaining significant predictors (openness and music flow) and music practice suggested that the associations between the variables were largely due to shared genetic influences with some additional non-shared environmental influences. Our findings suggest that common genes may influence both music practicing behavior and traits related to artistic interests and musical enjoyment (flow).     

Reactions to blindness: a four-year follow-up study

A previously studied group of newly blind adults was followed up after four years. There was only a slight increase in the acquisition of blind skills, while there was a surprising continuing pervasiveness of depression and poor health. A number of variables from the original study and from the follow-up data predicted outcome measures. Significant predictors of depression and distress were poor health, being married, being nonProtestant in this predominantly Protestant London population, and lacking ability to be more independent. Higher social class and an absence of a family history of blindness predicted greater distress. Earlier acceptance of blindness, early learning of blind skills, and better preillness adjustment predicted better coping and greater use of blind skills at follow-up. The extent of the depression and poor health are discussed, and recommendations are made for caregivers.     

Effects of IQ on Executive Function Measures in Children with ADHD

The present study compared children with Attention-Deficit Hyperactivity Disorder (ADHD) and controls on a selected set of clinical measures of executive function (EF). A total of 92 children (51 ADHD, 41 control), ages 6-16, completed measures chosen from a larger neuropsychological battery to illustrate diverse components of the EF construct (planning, inhibitory control, response preparation, memory search). The selected measures were moderately correlated with one another, and moderately correlated with IQ. After controlling for age, sex, presence of learning disability (LD), ADHD, and IQ test version, Full Scale IQ was significantly related to four of the five selected EF measures. A second analysis showed group differences on the EF measures at different IQ levels. After covarying for age, there was a significant multivariate effect for IQ level (average, high average, superior) and a significant multivariate interaction between group (ADHD vs. control) and IQ level. Three of the five selected EF measures showed significant univariate group effects (controls performing better than ADHD) at the average IQ level; however, there were no significant group differences between children with ADHD and controls at high average or superior IQ levels. These results suggest that clinical measures of EF may differ among children with ADHD and controls at average IQ levels, but there is poorer discriminatory power for these measures among children with above average IQ.     

Effects of IQ on executive function measures in children with ADHD.

The present study compared children with Attention-Deficit Hyperactivity Disorder (ADHD) and controls on a selected set of clinical measures of executive function (EF). A total of 92 children (51 ADHD, 41 control), ages 6-16, completed measures chosen from a larger neuropsychological battery to illustrate diverse components of the EF construct (planning, inhibitory control, response preparation, memory search). The selected measures were moderately correlated with one another, and moderately correlated with IQ. After controlling for age, sex, presence of learning disability (LD), ADHD, and IQ test version, Full Scale IQ was significantly related to four of the five selected EF measures. A second analysis showed group differences on the EF measures at different IQ levels. After covarying for age, there was a significant multivariate effect for IQ level (average, high average, superior) and a significant multivariate interaction between group (ADHD vs. control) and IQ level. Three of the five selected EF measures showed significant univariate group effects (controls performing better than ADHD) at the average IQ level; however, there were no significant group differences between children with ADHD and controls at high average or superior IQ levels. These results suggest that clinical measures of EF may differ among children with ADHD and controls at average IQ levels, but there is poorer discriminatory power for these measures among children with above average IQ.     

Insight into illness and adherence to psychotropic medications are separately associated with violence severity in a forensic sample

Violence towards others by a minority of psychotic individuals is a significant public health concern. The severity of this other-directed violence (ODV) in the community may be influenced by insight into illness and adherence to psychotropic medications; however, few studies have tested these associations. Sixty male psychotic inpatients, legally detained at a forensic unit in New York City, were assessed with semi-structured interviews, supplemented with information from hospital and official records, family members and the treating clinician. Results indicated that in this unique sample of detained persons with psychotic disorders; (1) increase in the severity of community violence is associated with medication non-adherence, all dimensions of poor insight into illness, and several previously reported covariates such as substance use comorbidity; (2) no relationship was found between insight and adherence in this particular sample; (3) multivariate analyses showed that select covariates, along with medication adherence, and select insight domains predicted a total of 73% of the magnitude of ODV behavior in this sample. Overall, medication non-adherence explained a large amount of how violently participants behaved toward others. Since non-adherence was independent of poor insight, it may be more worthwhile for clinicians to develop treatment strategies to target medication adherence without directly addressing an elusive target such as insight into illness. Treatment addressing medication adherence needs to concomitantly target substance use behaviors since the latter was responsible for a substantial increase in ODV.     

Predicting response to anxiety management in patients with generalised anxiety disorders

This paper describes the analysis of predictive factors in a group of generally anxious patients treated with anxiety management. Evidence for three reliable predictors is presented. It is argued these reflect anxiety, demoralisation and depression. The same three variables contributed to prediction of outcome after treatment and 6 months later, and their pre-treatment values classified 80% of the patients correctly into good or poor responders. Lower initial levels of anxiety and demoralisation together with higher depression rated by the assessor predicted a better outcome. Predictions were more accurate for patients with a mild degree of depression than for those who were not depressed.     

Burden in schizophrenia caregivers: impact of family psychoeducation and awareness of patient suicidality

Family caregivers of persons with schizophrenia and other psychotic disorders experience high levels of burden. Although a number of patient and caregiver predictors of burden have been identified, little research has investigated the contributions of patient depression, suicidal ideation, and substance abuse. In addition, family psychoeducation interventions have reduced patient symptoms, as well as inpatient treatment utilization; however, it is not known whether or not these interventions reduce family burden. This study investigated predictors of family burden and tested to what degree multiple family group treatment (MFGT), relative to a standard care condition, was associated with reduced family burden. Participants were 90 outpatients with a diagnosis of schizophrenia or other psychotic disorders, and their caregivers who were enrolled in a 2 year psychoeducation intervention. The best set of predictors of burden, identified by stepwise linear regression, was young patient age, awareness of patient's suicidal ideation, and family resources. These variables accounted for 32% of the total variance in burden. Findings suggest that caregiver's awareness of patient's suicidal ideation, not patient's report of suicidal ideation; and that patient age, not duration of the illness, were significant independent predictors of burden. When compared to a standard-care condition over 2 years, MFGT did not reduce family caregiver burden. Discussions focus on the relationship between burden and its predictors, and possible reasons why MFGT did not decrease burden. Modifications are proposed that may increase the impact of MFGT.     

A Test of Contextual Theory: The Relationship Among Relational Ethics,Marital Satisfaction,Health Problems,and Depression

Few studies have examined the theoretical underpinning of contextual theory. Using structural equation modeling, the relationship among relational ethics (recognized as the most important aspect of contextual theory), marital satisfaction, depression, and illness was examined. Data came from a national sample of 632 mid-life, married individuals. Results supported Nagy’s contextual theory. The total score of the Relational Ethics Scale was a significant predictor of marital satisfaction, and marital satisfaction was significantly associated with depression and health problems. Vertical and horizontal subscales of relational ethics also were significant predictors of depression and health problems through the mediating variable of marital satisfaction.     

A longitudinal study of motor ability and kinaesthetic acuity in young children at risk of developmental coordination disorder

Several studies have linked poor kinaesthetic ability with poor motor coordination in school-aged children. However, few studies have investigated kinaesthesis in younger children. The aim of this study was to determine if preschool aged children who have been identified as at risk of developing developmental coordination disorder (DCD) have poorer kinaesthetic ability than matched controls. Kinaesthetic ability and performance IQ were examined in a group of children aged between 4 and 5 years. Following individual assessment of 291 children, 31 were identified as at risk of DCD at this age. One year later, 30 of these children were retested, and 23 were still found to be at risk. These children were matched on verbal IQ, age and sex with control children and their performance compared on the kinaesthetic acuity test (KAT) [D.J. Livesey and N.A. Parkes, Aust. J. Psychol., 47 (1995) 160] and three subtests of the WPPSI-R performance IQ (D. Wechsler, Manual for the Wechsler preschool and primary scale of intelligence--revised, Psychological Corporation, New York, 1989). Both the KAT and the performance subtest scores were found to be significantly poorer in the children at risk of DCD. Follow-up testing one year later showed that both groups improved their kinaesthetic acuity score although the control children remained significantly better than the children with poor motor coordination.