Alcohol and Substance Use Disorders: Algorithms and Critical Pathways for Healthcare Delivery

Contemporary health care delivery is being driven by a changing health care market environments as well as by the availability of enhanced models of service delivery. Providers are using clinical algorithms and critical pathways to standardize clinical care and improve clinical services to patients. The article highlights the application of contemporary clinical models and demonstrates their utility in the context of substance use and abuse disorders. Clinical algorithms and critical pathways are advanced as guidelines in diagnostic and therapeutic processes for the delivery of quality health care to patients. Specific recommendations for the development and implementation of such initiatives are discussed in detail.     

Common and Unique Factors Associated with DSM-IV-TR Internalizing Disorders in Children

With the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association. Diagnostic and statistical manual of mental disorders DSM-IV Fourth Edition-Text Revision. Author, Washington, DC. 2000) ahead, decisions will be made about the future of taxonomic conceptualizations. This study examined the factor structure of items from three internalizing disorders (Social Phobia, Generalized Anxiety Disorder, and Depression) on the Anxiety Disorders Interview Schedule for DSM-IV-Child Version (Silverman, W. K., & Albano, A. M. Anxiety disorders interview schedule for children for DSM-IV, child and parent versions. Psychological Corporation, San Antonio, 1996). Two-, three-, and four-factor models emerged in an exploratory factor analysis. Confirmatory factor analysis provided additional empirical support for the four-factor model over the two- or three-factor models. Implications for the structure of the DSM-V taxonomy in children and adolescents are discussed.     

Basal Ganglia and Thalamic Contributions to Language Function: Insights from A Parallel Distributed Processing Perspective

Neuropsychology Review - Cerebral representations are encoded as patterns of activity involving billions of neurons. Parallel distributed processing (PDP) across these neuronal populations provides...     

Disruption in Pavlovian-Instrumental Transfer as a Function of Depression and Anxiety

The Pavlovian-Instrumental Transfer (PIT) paradigm examines probabilistic and reinforcement learning. Disruptions in mechanisms that mediate PIT (i.e., cues not triggering adaptive behaviors) are thought to be contributors to psychopathology, making the study of probabilistic and reinforcement learning clinically relevant. The current study evaluated an appetitive PIT effect and its relationship with symptom dimensions spanning depression and anxiety, with a particular focus on anhedonia. Forty young adults ranging in scores across dimensions of depression and anxiety symptoms completed the PIT paradigm and self-report symptom measures. The PIT paradigm consisted of three phases. The instrumental phase consisted of a contingent association in which participants squeezed a handgrip for monetary reward. The Pavlovian phase established a purely predictive association between three visual stimuli (CS?+?, CS-, baseline) and presence or absence of monetary reward. In the transfer phase, participants’ responses allowed for examination of whether motivational characteristics of Pavlovian predictors influenced the vigor of their handgrip squeezes (instrumental action), which were formerly independent of Pavlovian associations. Analyses revealed a baseline-reward PIT effect, whereby a reward-associated Pavlovian cue enhanced instrumental responding in the transfer phase. However, there were no significant differences between CS?+?and CS- or CS- and baseline cues, suggesting a disrupted interaction of Pavlovian and instrumental learning. Further, the appetitive PIT effect captured in this paradigm was not associated with anhedonia, fears, or general distress. Future work should investigate the influence of mood states using more specific appetitive PIT paradigms to further understanding of the implications of disrupted reflexive and instrumental responding.

     

Psychiatric Disorders Associated with Substance Use Among Children and Adolescents: Findings from the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study

The relationships between specific quantities and frequencies of alcohol, cigarette, and illicit substance use and substance use (SUD) and other psychiatric disorders were investigated among 1,285 randomly selected children and adolescents, aged 9 to 18, and their parents, from the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. Logistic regressions indicated that daily cigarette smoking, weekly alcohol consumption, and any illicit substance use in the past year were each independently associated with an elevated likelihood of diagnosis with SUD and other psychiatric disorders (anxiety, mood, or disruptive behavior disorders), controlling for sociodemographic characteristics (age, gender, ethnicity, family income). The associations between the use of specific substances and specific psychiatric disorders varied as a function of gender.     

Brain Function Associated with Cooccurring Trauma and Depression Symptoms in College Students

The goal of this pilot study was to determine if functional brain differences are present among individuals with high and low cooccurring trauma and depression symptoms. This pilot study examined how the P300 latency component of event-related potentials (ERPs), measured using electroencephalography (EEG) while participants performed a go/no-go task, might be associated with cooccurring self-report of trauma and depression symptoms in a sample of college students (N = 38). Alpha-corrected independent sample t tests revealed statistically significant differences in ERP P300 peak latencies between those in the high cooccurring trauma and depression symptoms group (n = 12) and those in the low group (n = 26) for all 3 midline electrode sites (Fz, Cz, and Pz). This pilot study provides preliminary evidence of differential brain functioning in individuals experiencing cooccurring trauma and depression symptoms. Accordingly, these findings support future research examining brain functioning in cooccurring symptoms.     

Profiles of Everyday Executive Function in Acquired and Developmental Disorders

The current study focused on the early development of inhibitory control in 5- to 7-year-old children attending kindergarten in two Eastern-European countries, Romania and Russia. These two countries share many aspects of child-rearing and educational practices, previously documented to influence the development of inhibitory control. Using the Lurian-based developmental approach offered by the Developmental Neuropsychological Assessment battery, the study aimed to contribute to cross-cultural developmental neuropsychology by exploring (a) early interrelationships between subcomponents of inhibitory control (response suppression and attention control) and generative fluency (verbal and figural) in these two cultures, as well as (b) the predictive value of external factors (culture and maternal education) and individual differences (age, gender, nonverbal intelligence, trait anxiety) on inhibitory control and fluency outcomes in children from both countries. First, findings in both culture samples suggest that even at this young age, the construct of inhibitory control cannot be considered a unitary entity. Second, differences in maternal education were not predictive of either inhibitory control or fluency scores. However, children’s attention control performance varied as a function of culture, and the direction of these cultural effects differed by whether the target outcome involved performance accuracy versus efficiency as an output. Findings also confirmed the previously documented intensive developmental improvement in preschoolers’ inhibitory control during this period, influencing measures of response suppression and particularly attention control. Finally, the results further stress the importance of individual differences effects in trait anxiety on attention control efficiency across cultures.     

The Experience of Caregiving Among Mothers of Adults Suffering from Psychotic Disorders: Factors Associated with Their Psychological Distress

To identify correlates of psychological distress among multiple indicators, 99 women with adult children suffering from a psychotic disorder were interviewed. The women, who were recruited through hospitals and self-help groups, represented different socioeconomic levels. A face-to-face standardized interview was conducted, mainly in the participants' homes. Multiple hierarchical regression analysis showed that dimensions of burden and social support were strongly associated with distress reported by the participants. The negative interactions that participants had with their main confidant or spouse constituted a more powerful correlate than their perception of the quality of this relationship. Furthermore, a perception of their own health as poorer is a strong correlate of their distress. Since no control group was studied simultaneously, these results suggest, but do not prove, the presence of differences between mothers of adults with psychotic disorders and other mothers.     

Anxiety Disorders in Children and Adolescents with Autistic Spectrum Disorders: A Meta-Analysis

There is considerable evidence that children and adolescents with autistic spectrum disorders (ASD) are at increased risk of anxiety and anxiety disorders. However, it is less clear which of the specific DSM-IV anxiety disorders occur most in this population. The present study used meta-analytic techniques to help clarify this issue. A systematic review of the literature identified 31 studies involving 2,121 young people (aged <18 years) with ASD, and where the presence of anxiety disorder was assessed using standardized questionnaires or diagnostic interviews. Across studies, 39.6% of young people with ASD had at least one comorbid DSM-IV anxiety disorder, the most frequent being specific phobia (29.8%) followed by OCD (17.4%) and social anxiety disorder (16.6%). Associations were found between the specific anxiety disorders and ASD subtype, age, IQ, and assessment method (questionnaire versus interview). Implications for the identification and treatment of anxiety in young people with ASD are discussed.     

Traumatic Events,Psychiatric Disorders,and Pathways of Risk and Resilience During the Transition to Adulthood

The goal in this study was to investigate the occurrence, frequency, and consequences of traumatic events during the first 2 decades of life. The sample omprised 524 Euro-American young adults from the rural Midwest who are part of an ongoing longitudinal study (see Conger & Conger, 2002). We found that psychiatric disorders were associated with traumatic events and particularly strongly associated with experiences of childhood maltreatment. Maltreated children were 5.64 times more likely to develop a disorder than individuals who xperienced no trauma. These odds varied, depending on the disorder, from more than 3 for alcohol dependence to more than 18 for drug dependence. We found that social support acted to reduce risk for emotional disorder and buffered effects of traumatic events under some circumstances, especially in cases of childhood trauma.     

Executive Function in Pediatric Bipolar Disorder and Attention-Deficit Hyperactivity Disorder: In Search of Distinct Phenotypic Profiles

Often, there is diagnostic confusion between bipolar disorder (BD) and attention-deficit hyperactivity disorder (ADHD) in youth due to similar behavioral presentations. Both disorders have been implicated as having abnormal functioning in the prefrontal cortex; however, there may be subtle differences in the manner in which the prefrontal cortex functions in each disorder that could assist in their differentiation. Executive function is a construct thought to be a behavioral analogy to prefrontal cortex functioning. We provide a qualitative review of the literature on performance on executive function tasks for BD and ADHD in order to determine differences in task performance and neurocognitive profile. Our review found primary differences in executive function in the areas of interference control, working memory, planning, cognitive flexibility, and fluency. These differences may begin to establish a pediatric BD profile that provides a more objective means of differential diagnosis between BD and ADHD when they are not reliably distinguished by clinical diagnostic methods.     

Stress Sensitization and Adolescent Depressive Severity as a Function of Childhood Adversity: A Link to Anxiety Disorders

The goal of the present study was to determine whether exposure to adversity in childhood contributes to a differential threshold at which stressful life events provoke depressive reactions in adolescence. In addition, to address empirical and conceptual questions about stress effects, the moderating effect of anxiety disorder history was also explored. This examination was conducted in a sample of 816 children of depressed and nondepressed mothers, who were followed from birth to age 15. Information on adversities experienced in childhood was collected both from mothers during the first five years of their youth's life and from the youths themselves at age 15, and included information on the mother's relationship with her partner, maternal psychopathology, as well as youth-reported abuse. Results indicated that youths with both greater exposure to adversity in childhood and a history of an anxiety disorder displayed increased depressive severity following low levels of episodic stress compared to youths with only one or neither of these risk factors. The results are speculated to reflect the possibility that early anxiety disorders associated with exposure to adversity in childhood may be a marker of dysregulated stress responses, and may help to account for the comorbidity of depression and anxiety in some individuals.     

Affective Comorbidity Associated with Symptoms,Lung Function,and Differences Between Patients with COPD for Biomass and Tobacco Smoke Exposure

Journal of Clinical Psychology in Medical Settings - Anxiety and depression are common entities in patients diagnosed with Chronic Obstructive Pulmonary Disease (COPD). This study aimed to...     

Penalties for Rape as a Function of Victim Provocativeness, Damage, and Resistance

Subjects responded to one of four cases of rape which they read by indicating how many years in prison the rapist should serve as a penalty. In Experiment 1, the cases presented the victim as either provocatively dressed or nonprovocatively dressed, and either pregnant as a result of the rape or not pregnant. Older subjects gave significantly higher penalties when the victim was pregnant, while younger subjects did not. In Experiment 2, the cases presented the victims as being either raped or robbed and as resisting or not resisting her attacker. Male subjects gave significantly lower penalties when the victim did not resist, while female subjecis gave higher penalties when the victim did not resist-this interaction being significant for both crimes.     

Distress and Empathy: Two Qualitatively Distinct Vicarious Emotions with Different Motivational Consequences

The construct of empathy may be located conceptually at several different points in the network of interpersonal cognition and emotion. We discuss one specific form of emotional empathy--other-focused feelings evoked by perceiving another person in need. First, evidence is reviewed suggesting that there are at least two distinct types of congruent emotional responses to perceiving another in need: feelings of personal distress (e.g., alarmed, upset, worried, disturbed, distressed, troubled, etc.) and feelings of empathy (e.g., sympathetic, moved, compassionate, tender, warm, softhearted, etc.). Next, evidence is reviewed suggesting that these two emotional responses have different motivational consequences. Personal distress seems to evoke egoistic motivation to reduce one's own aversive arousal, as a traditional Hullian tension-reduction model would propose. Empathy does not. The motivation evoked by empathy may instead be altruistic, for the ultimate goal seems to be reduction of the other's need, not reduction of one's own aversive arousal. Overall, the recent empirical evidence appears to support the more differentiated view of emotion and motivation proposed long ago by McDougall, not the unitary view proposed by Hull and his followers.     

积极社会心态：正念培育的目标、机制与途径

正念培育积极社会心态,指运用正念的理论、方法与技术促进积极社会心态的培养、教育和引导,并将消极社会心态转化为积极社会心态的过程。其可能的机制为：通过正念养育、正念教育、正念社区与正念生产提高个体与情境正念,在复杂系统中经过循环反应、内隐互动和价值累加来培育和转化社会心态。未来应建构正念公共心理服务体系;区分世俗化与宗教化的正念;研究内隐正念和积极社会心态的关系;从东方传统文化中汲取营养。     

Father-Child and Mother-Child Interactions with Children with Anxiety Disorders: Emotional Expressivity and Flexibility of Dyads

This observational study examined whether emotional expressivity and emotional flexibility differed between parent-child dyads with and without children with an anxiety disorder (AD). Effects of parents’ own AD on emotional expressivity and flexibility of dyads was also studied. The sample consisted of 128 referred children (59.4% girls) with an AD (8–18-year-olds) and both of their parents, and 44 matched non-AD children (63.6% girls) and both of their parents. Father-child and mother-child dyads were videotaped while discussing a conflict. Measures of dyadic emotional expressivity (positive and negative affect) and dyadic emotional flexibility (transitions, dispersion, average duration) were derived from these interactions using state space grid analysis. No differences existed in emotional expressivity of parent-child dyads with or without AD children, however both father-child and mother-child dyads with a child with an AD displayed less emotional flexibility during interactions than healthy controls. Mother-child dyads where both mother and child had AD showed more emotional expressivity and less emotional flexibility compared to mother-child dyads with only AD children and to dyads without AD. In particular, the inability to flexibly move in and out of different emotions distinguishes healthy dyads from non-healthy dyads. Targeting emotional flexibility of dyads with children with an AD, and also emotional expressivity of dyads when mother has an AD, might be a valuable goal for family-based intervention.     

Social Anxiety in Children with Anxiety Disorders: Relation with Social and Emotional Functioning

Investigated the psychometric properties of the Social Anxiety Scale for children-Revised (SASC-R) as well as relations between social anxiety and children's social and emotional functioning. Participants were a clinic sample of children, ages 6–11 with anxiety disorders (N = 154) who completed the SASC-R. For a subset of these children, parent ratings of social skills, and self-ratings of perceived competence and peer interactions were also obtained. Factor analysis of the SASC-R supported the original three-factor solution and internal consistencies were in the acceptable range. Among children with simple phobia, scores on the SASC-R differentiated those with and without a comorbid social-based anxiety disorder. Social anxiety was also associated with impairments in social and emotional functioning. Specifically, highly socially anxious children reported low levels of social acceptance and global self-esteem and more negative peer interactions. Girls with high levels of social anxiety were also rated by parents as having poor social skills, particularly in the areas of assertive and responsible social behavior.