Theory-Driven Interventions in Psychoneuroimmunology and HIV-1 Infection

Psychoneuroimmunology (PNI) is a rapidly evolving multidisciplinary field founded on the premise that psychosocial factors, the central nervous system, and the immune system are intimately linked. Following publication of scientific evidence supporting this link, a number of animal and human studies have been published, both inside and outside the area of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome. These studies support the existence of bidirectional feedback mechanisms operating between the brain and the immune system. To date, however, there is no all-encompassing model that predicts individual differences in the relationship among psychosocial factors, immunologic measures, and clinical disease progression in HIV type 1 (HIV-1) infection. This variability in human response has been explained by a number of cofactors (host as well as environmental) that appear to accelerate the course of the disease. Since psychosocial factors are highly amenable to behavioral interventions, several models for intervention research have been proposed to evaluate whether such interventions can enhance immune functioning, thereby curtailing disease progression. Examination of these interventions in the context of PNI and HIV-1 infection, however, is rather limited. Therefore, researchers and clinicians must not only consider conceptualizations and paradigms in this area of research, but also focus on empirically testable, theory-driven models that allow for the unique characteristics of individual patients.     

Loneliness is a unique predictor of age-related differences in systolic blood pressure

A population-based sample of Caucasians, African Americans, and Latino Americans, 50-68 years of age (M = 57.5), from Cook County, Illinois (N = 229), was tested to examine how loneliness and co-occurring psychosocial factors (depressive symptoms, perceived stress, social support, and hostility) were related to indices of cardiovascular and endocrine functioning. Extending prior research, the authors found that loneliness was associated with elevated systolic blood pressure (SBP) and age-related increases in SBP, net of demographic variables, health behavior variables, and the remaining psychosocial factors. Loneliness was not associated with differences in autonomic or endocrine functioning. Although the results are limited by the cross-sectional methods used, they are consistent with the hypothesis that cardiovascular disease contributes to increased morbidity and mortality among lonely individuals.     

Prediction of drug and alcohol abuse in hospitalized adolescents: comparisons by gender and substance type

The authors examined psychosocial correlates of drug and alcohol abuse in 462 hospitalized adolescents, and the extent to which these associations may be affected by gender or by substance type. Participants completed a battery of psychometrically-sound, self-report measures of psychological functioning, environmental stress, drug abuse, and alcohol abuse. Four multiple regression analyses were conducted to determine the joint and independent predictors of drug abuse and alcohol abuse, for males and for females. Multiple regression analysis revealed that seven variables--age, depression, impulsivity, low self-esteem, delinquent predisposition, low peer insecurity, and history of child abuse--jointly predicted both drug and alcohol abuse, for both males and females. However, several differences were found with respect to which variables made independent contributions to the predictive models--with only delinquent predisposition making a significant independent contribution for all four conditions. We found distinct patterns of psychosocial predictor variables for drug and alcohol abuse, as well as distinct patterns for males and females. These results may reflect differing risk factors for drug abuse and alcohol abuse in adolescent psychiatric patients--and differing risk factors for males and females. Such differences have potential implications for prevention and treatment.     

Possible contributors to the gender differences in alcohol use and problems

Research on alcohol use and problems has demonstrated a much higher rate of alcohol use disorders (AUDs) among men compared with women. The authors review the most frequently researched biological and psychosocial factors that may play a role in the gender differences in alcohol use and problems. Among the biological factors, women might carry a lower genetic risk for AUDs and tend to suffer more negative biological consequences from drinking as compared with men. Regarding psychosocial factors, men appear to be more likely than women to manifest certain risk factors for alcohol use and problems (e.g., fewer perceived social sanctions for drinking, positive expectancies for alcohol use, personality traits such as impulsivity) and have fewer protective factors. Although these findings have helped to explain some of the gender differences in alcohol use and problems, there are inconsistencies in the literature. Additionally, many studie may not have enough statistical power to detect gender differences. The authors suggest that the biological and social consequences of alcohol abuse for women may be especially potent protective factors against AUDs and discuss the possibility of public health campaigns developed on the basis of this idea.     

Psychosocial Stress and Cardiovascular Risk: What is the Role of Daily Experience?

We describe an ecological momentary assessment (EMA) protocol designed to measure daily life experiences along several psychosocial dimensions (Social Conflict, Task Demand, Decisional Control, Negative Affect, and Arousal) hypothesized to be relevant for cardiovascular disease risk. In a large community sample, these assessments have been administered in conjunction with ambulatory blood pressure (ABP) monitoring and measures of subclinical cardiovascular disease. Several results have emerged that support the promise of this approach. First of all, each of these dimensions of experience appears to be a trigger for cardiovascular activation, with movement on each scale being associated with significant within-person changes in heart rate and blood pressure in the natural environment. Second, there appear to be individual differences in physiological responsiveness to these dimensions of daily experience, with such differences being associated in some cases with laboratory-based assessments of cardiovascular reactivity, as might be expected. Third, EMA ratings are associated in several instances with (between-person) stable individual differences in ABP readings. And finally, we have found that some of the characteristics defined by our EMA ratings are related to measures of subclinical atherosclerosis. Such effects appear to be mediated, in part, by ABP. The advantages of using EMA measures for capturing the effects of psychosocial stressors are highlighted by comparing the predictive validity of these daily life assessments to traditional global self-reports. We conclude by describing future plans for use of this type of assessment protocol for helping us to characterize psychosocial characteristics relevant to cardiovascular disease risk. Personality and social processes during daily living may have an important impact not only on psychological functioning but also on physical health and disease. In this article we review our recent work involving the assessment of daily experience as a means of better understanding the role of psychosocial stress in cardiovascular disease risk. First, we outline the rationale for our interest in daily experience sampling for examining these processes, and we describe the methods we have adopted for this purpose. Next, we review findings from a recent study in which we have used these approaches to examine the role of psychosocial stress on ABP and atherosclerosis in a community-dwelling sample. We compare our approach to more traditional (global self-report and laboratory-observation) methods for examining these relationships in humans, and we discuss potential future directions for use of daily experience sampling in studies of health and behavior.     

Attention development in infants and preschool children born preterm: a review

A potential mechanism that can explain preterm children's heightened risk for the development of later cognitive and behavioral problems is attention. Attention is the ability of an infant or child to orient to, to shift between and to maintain focus on events, objects, tasks, and problems in the external world, processes which are all dependent on the functioning of attentional networks in the brain. The aim of this paper is to provide a review of the literature on attention development in children born preterm during the first 4 years of life. First, research examining the differences between preterm and full-term children indicates that early attention development in infants born preterm is less optimal and that these differences increase when infants grow into toddlers. Second, studies investigating individual differences within preterm populations reveal the influence of both biological factors and environmental factors. Third, individual differences in early orienting and sustained attention have been shown to be predictive of later attentional, cognitive and behavioral functioning in children born preterm. The importance of long-term follow-up studies, with a focus on individual developmental trajectories in orienting, sustained and executive attention, is emphasized.     

Same-sex attraction, social relationships, psychosocial functioning, and school performance in early adolescence

The authors examined whether 13- to 15-year-old adolescents who experience feelings of same-sex attraction (SSA) differ from those without such feelings in the quality of relationships with parents, peers, and class mentors and in psychosocial functioning (health status and school performance). The authors also assessed whether differences in psychosocial functioning resulted from differences in the quality of social relationships. Data were collected from 866 Dutch high school students (mean age 13.61 years) by means of a computer-based questionnaire. Of the participants, 74 (8.5%) reported having feelings of SSA. The participants with SSA rated the quality of their relationships with their fathers and their peers lower than did those without SSA. Participants with SSA also had poorer mental health (higher levels of depression and lower levels of self-esteem) and lower school performance. A mediation analysis revealed that differences in psychosocial functioning resulted from differences in the quality of the same-sex attracted youths' social relationships, especially with fathers and peers.     

Child sexual abuse, early family risk, and childhood parentification: pathways to current psychosocial adjustment.

In this study, the authors examined the role of parentification (children assuming adult-like roles in the family) as it relates to family risk (parental psychopathology, parental illness, and domestic violence), child sexual abuse (CSA), and psychosocial adjustment in 499 college women. Structural equation modeling was used to test a model of direct, indirect, and mediational pathways through which CSA, family risk, and parentification contributed to later psychosocial maladjustment. Results indicate that CSA and family risk independently and directly predicted higher levels of maladjustment, but only family risk positively predicted parentification in childhood. Parentification was unexpectedly related to less maladjustment. Parentification failed to mediate the relation between early family risk and maladjustment. Findings suggest that family risk factors may contribute to parentification and that parentification is not always related to poorer psychosocial outcomes. Future research should examine the impact of parentification on other aspects of functioning and should assess how individual, familial, and cultural variables (e.g., age, gender, duration, perceived fairness, ethnicity, and family support) moderate the impact of parentification on long-term adjustment.     

Variations in internet-related problems and psychosocial functioning in online sexual activities: implications for social and sexual development of young adults.

This survey of 760 university students examined differences in Internet-related problems and psychosocial functioning between four patterns of participation in online sexual information and entertainment activities. Students who did not participate in either online sexual activity were more satisfied with their offline life and more connected to friends and family. Those who engaged in both online sexual activities were more dependent on the Internet and reported lower offline functioning. Students who only sought sexual information maintained strong offline affiliations. Those who only sought entertainment did not report lower offline functioning. Respondents most deficient in offline social support did not report compensatory online support. Despite students' common participation in online sexual activities (OSA) as a venue for social and sexual development, those relying on the Internet and the affiliations it provides appear at risk of decreased social integration. The authors discussed the finding's implications for social and sexual development.     

Infant Parasympathetic and Sympathetic Activity during Baseline,Stress and Recovery: Interactions with Prenatal Adversity Predict Physical Aggression in Toddlerhood

Exposure to prenatal adversity is associated with aggression later in life. Individual differences in autonomic nervous system (ANS) functioning, specifically nonreciprocal activation of the parasympathetic (PNS) and sympathetic (SNS) nervous systems, increase susceptibility to aggression, especially in the context of adversity. Previous work examining interactions between early adversity and ANS functioning in infancy is scarce and has not examined interaction between PNS and SNS. This study examined whether the PNS and SNS moderate the relation between cumulative prenatal risk and early physical aggression in 124 children (57% male). Cumulative risk (e.g., maternal psychiatric disorder, substance (ab)use, and social adversity) was assessed during pregnancy. Parasympathetic respiratory sinus arrhythmia (RSA) and sympathetic pre-ejection period (PEP) at baseline, in response to and during recovery from emotional challenge were measured at 6 months. Physical aggression and non-physical aggression/oppositional behavior were measured at 30 months. The results showed that cumulative prenatal risk predicted elevated physical aggression and non-physical aggression/oppositional behavior in toddlerhood; however, the effects on physical aggression were moderated by PNS and SNS functioning. Specifically, the effects of cumulative risk on physical aggression were particularly evident in children characterized by low baseline PNS activity and/or by nonreciprocal activity of the PNS and SNS, characterized by decreased activity (i.e., coinhibition) or increased activity (i.e., coactivation) of both systems at baseline and/or in response to emotional challenge. These findings extend our understanding of the interaction between perinatal risk and infant ANS functioning on developmental outcome.     

Autonomic functioning in reactive versus proactive aggression: The influential role of inconsistent parenting

Research has consistently supported autonomic nervous system (ANS) functioning as a predictor of aggressive behavior in youth. Several studies have further examined how the functioning of the sympathetic (SNS) and parasympathetic (PNS) branches of the ANS interact with environmental factors to predict behavioral outcomes. One factor that has yet to be studied in this context however, is parenting practices. Given that many interventions for externalizing behavior target parenting practices, such as increasing consistent discipline, it may be particularly important to assess whether parenting practices interact with SNS and PNS functioning in the child to influence risk for aggressive behavior. Therefore, the current study addressed this question by examining inconsistent discipline as a moderator of the relationship between baseline SNS versus PNS activity and reactive versus proactive aggression. Data were collected from a sample of fourth graders identified as at‐risk for aggression (N = 188). Results indicated that baseline SNS activity was positively related to proactive aggression under high levels of inconsistent discipline, but negatively related to proactive aggression under very low levels of inconsistent discipline. Baseline PNS activity was negatively associated with reactive aggression under low levels of inconsistent discipline. No main effects were found for SNS or PNS functioning and either form of aggression, emphasizing the importance of taking a biosocial approach to examining the predictors of aggressive behavior in at‐risk youth. Results from this study help to better understand the circumstances under which children are most likely to exhibit reactive versus proactive aggression, better informing targeted prevention and treatment.

     

反社会人格障碍的神经生物学基础及其司法启示

反社会人格障碍(Antisocial Personality Disorder, ASPD)是一种漠视或侵犯他人权益的普遍行为模式, 是与犯罪关联极高的精神障碍。ASPD的形成受基因和环境因素的影响, 表现为神经递质和激素系统的紊乱, 以及自主神经系统活跃程度和大脑结构与功能的异常。上述神经生物学因素可能导致ASPD患者表现出执行控制障碍、情绪功能障碍、无视惩罚信息和奖赏偏好等特点。神经生物学研究的证据为ASPD罪犯的循证矫治、风险评估、定罪量刑等司法实践提供了启示。建议未来从神经生物学角度对ASPD的诊断分类标准、治疗方法和影响因素等方面开展研究。     

A genetically informed study of associations between family functioning and child psychosocial adjustment

Research has documented associations between family functioning and offspring psychosocial adjustment, but questions remain regarding whether these associations are partly due to confounding genetic factors and other environmental factors. The current study used a genetically informed approach, the Children of Twins design, to explore the associations between family functioning (family conflict, marital quality, and agreement about parenting) and offspring psychopathology. Participants were 867 twin pairs (388 monozygotic; 479 dizygotic) from the Twin and Offspring Study in Sweden, their spouses, and children (51.7% female; M = 15.75 years). The results suggested associations between exposure to family conflict (assessed by the mother, father, and child) and child adjustment were independent of genetic factors and other environmental factors. However, when family conflict was assessed using only children's reports, the results indicated that genetic factors also influenced these associations. In addition, the analyses indicated that exposure to low marital quality and agreement about parenting was associated with children's internalizing and externalizing problems and that genetic factors also contributed to the associations of marital quality and agreement about parenting with offspring externalizing problems.     

Psychosocial Functioning in Children and Adolescents with Gastrointestinal Complaints and Disorders

The current study examined the prevalence and presentation of psychosocial symptoms in pediatric patients and their parents presenting for first time appointments at a gastroenterology (GI) clinic compared to healthy controls (HC). One hundred GI patients, aged 8-17 years, and their mothers were compared to 100 age- and gender-matched HC on measures of child and parental behavioral/psychosocial functioning, depression, and anxiety. Results revealed significant correlations between mother- and child-reported internalizing behaviors and psychological symptoms. Significant group differences were observed in internalizing problems, adaptive and social skills, and leadership competency, as well as parental interpersonal sensitivity, depression, phobic anxiety, and number of psychological symptoms. GI patients are at increased risk for psychosocial and social dysfunction compared to healthy peers. Psychosocial factors should be considered when assessing patients in GI clinics. Patients might benefit from treatment plans that involve adjunctive behavioral intervention to assist patients in managing their conditions.     

Spontaneous startle activity in newborn infants

Spontaneous startles have been reported to occur most frequently in quiet sleep, less frequently in active sleep and drowse, and relatively nonexistent in the waking states. These findings may be a result of a focus on infants whose prenatal histories reflect a restricted range of the conditions to which normal newborns are exposed. The present study examined the spontaneous startle behavior of 30 newborn infants characterized by high numbers of obstetric complications and by indicators of prenatal malnutrition, but within the range of normal, healthy newborns. In this sample, startles were not limited to the sleep and drowse states. Because individual differences in a number of neonatal behaviors have been related to autonomic nervous system (ANS) functioning, the different pattern of spontaneous startles observed in this sample may be related to the functional integrity of this system.     

Chronic psychosocial factors and acute physiological responses to laboratory-induced stress in healthy populations: a quantitative review of 30 years of investigations

This meta-analysis included 729 studies from 161 articles investigating how acute stress responsivity (including stress reactivity and recovery of hypothalamic-pituitary-adrenal [HPA] axis, autonomic, and cardiovascular systems) changes with various chronic psychosocial exposures (job stress; general life stress; depression or hopelessness; anxiety, neuroticism, or negative affect; hostility, aggression, or Type-A behavior; fatigue, burnout, or exhaustion; positive psychological states or traits) in healthy populations. In either the overall meta-analysis or the methodologically strong subanalysis, positive psychological states or traits were associated with reduced HPA reactivity. Hostility, aggression, or Type-A behavior was associated with increased cardiovascular (heart rate or blood pressure) reactivity, whereas anxiety, neuroticism, or negative affect was associated with decreased cardiovascular reactivity. General life stress and anxiety, neuroticism, or negative affect were associated with poorer cardiovascular recovery. However, regarding the sympathetic nervous system and parasympathetic nervous system, there were no associations between the chronic psychosocial factors and stress reactivity or recovery. The results largely reflect an integrated stress response pattern of hypo- or hyperactivity depending on the specific nature of the psychosocial background.     

Children's influence in the marital relationship.

In a 3-wave longitudinal study, the authors tested hypotheses regarding children's influence on the marital relationship, examining relations between interparental discord and children's negative emotional reactivity, agentic behavior, dysregulated behavior, and psychosocial adjustment. Participants were 232 cohabiting mothers and fathers who completed questionnaires and a marital conflict resolution task. Consistent with theory, interparental discord related to children's negative emotional reactivity, which in turn related to children's agentic and dysregulated behavior. Agentic behavior related to decreases in interparental discord, whereas dysregulated behavior related to increases in discord and elevations in children's adjustment problems. Person-oriented analyses of agentic and dysregulated responses indicated distinct clusters of children linked with meaningful individual differences in marital and psychosocial functioning. Results are discussed in terms of possible mechanisms of child effects, such as increased parental awareness of children's distress potentially leading to reduced marital conflict.     

Psychophysiological theories on sympathetic nervous system reactivity in the development of essential hypertension

Psychophysiological theories on the development of essential hypertension are reviewed and evaluated. Two interconnected theories that relate behavior to essential hypertension and account for individual differences in susceptibility to disease are the "hyperreactivity" theory and "the symptom specificity" theory. The "hyperreactivity" theory identifies individual differences in autonomic nervous system reactivity as the pathophysiological mechanism and the "symptom specificity" theory suggests that inflexible, stereotypical responding increases the risk to develop hypertension. Based on a literature review, these theories are examined. There exist both case/control and prospective studies on autonomic nervous system reactivity and the development of hypertension. It is concluded that a neurogenically mediated hyperreactivity to stress is a precursor and not an effect of hypertension. Tasks that call for active but not passive coping efforts are more efficient elicitors of reactivity differences between those at high and low risk to develop hypertension in case/control studies. In prospective studies, active tasks may also have a predictive advantage over passive with respect to blood pressure development. In the early phase of hypertension, an increased cardiovascular reactivity is accompanied by increased neuroendocrine activation. In the later phase, heightened reactivity is confined to the cardiovascular system. This does not prove but is consistent with the notion that transient episodes of increased cardiac output translate into essential hypertension by causing vascular hypertrophy. Case/control studies suggest that an increased "symptom specificity", with stereotypical responding across multiple stressors, is independent of cardiovascular reactivity and a precursor of hypertension. The literature lacks prospective studies on the clinical relevance of stereotypical responding. It is suggested that the presence of both hyperreactivity and symptom specificity in a single individual increases the risk to develop essential hypertension.     

Neurocognitive outcomes in children with chronic kidney disease: Current findings and contemporary endeavors

Given the rise in chronic kidney disease (CKD) in both children and adults, CKD has recently been targeted as a public health priority. Childhood onset kidney disease is generally a noncurable and progressive condition that leads to kidney failure by early adulthood. Fortunately, improved identification of kidney problems allows for early intervention, which is thought to slow progression toward end-stage renal disease. In addition, medical interventions for pediatric end-stage renal disease have also improved, allowing children to take advantage of lifesaving renal replacement treatments such as dialysis and kidney transplantation. In spite of improvements in identification and treatment, CKD causes both direct and indirect insults to a variety of organ systems. This paper reviews recently published studies pertaining to the neurocognitive and psychosocial impact of CKD on children of various ages and at various stages of kidney failure. Specific attention is focused on summarizing peer reviewed research that describes associations between kidney functioning and cognitive functioning, language acquisition, visual spatial abilities, memory, and executive functioning. In addition, peer reviewed research describing psychosocial outcomes associated with CKD related to academic achievement, social-behavioral functioning, and quality of life are summarized. The authors also identified disease-specific factors that likely mediate neurocognitive outcomes (e.g., anemia, hypertension, cardiovascular) and endorse the importance of continued interdisciplinary research collaborations that will provide a better understanding of the mechanisms responsible for improved neurocognitive functioning after transplantation. The authors conclude this review by describing a multicenter, prospective, longitudinal, National Institutes of Health funded study that is currently examining the developmental outcomes of children with mild to moderate CKD. The authors speculate that the Chronic Kidney Disease in Children Prospective Cohort Study (CKiD) findings will provide additional evidence-based guidance for clinicians and researchers working with children and adolescents with deteriorating kidney function to improve medical and developmental outcomes.     

Feasibility of Conducting Long-Term Follow-Up of Children and Infants Treated for CNS Tumors on the Same Cooperative Group Clinical Trial Protocol

Given the barriers to conducting long-term assessment of neurocognitive and psychosocial functioning of those treated in infancy for central nervous system (CNS) tumors, a multi-site feasibility study was conducted. The primary objective was to demonstrate that it is feasible to identify, locate and assess the functioning of children treated on the same protocol 10-years post-treatment. Six sites obtained institutional approval, identified and recruited subjects, and obtained comprehensive neurocognitive and psychosocial data. All feasibility objectives were met. Barriers to participation included length of time for Institutional Review Board submission and review, clinical demands, limited eligible participants at individual institutions, difficulty locating long-term subjects and stipend/reimbursement concerns. Results indicate that long-term studies are feasible and essential given the need to address long-term issues of children treated at a young age for CNS tumors, especially as they relate to later academic and vocational planning, but require significant coordination and commitment of cooperative group and institutional resources.