Impulsivity and Suicidality in Adolescent Inpatients

Suicide is the second leading cause of death among adolescents, and impulsivity has emerged as a promising marker of risk. The present study tested whether distinct domains of impulsivity are differentially associated with suicide ideation, plans, and attempts. Adolescents (n?=?381; boys?=?106, girls?=?275) aged 13–19 years (M?=?15.62, SD?=?1.41) were recruited from an acute, residential treatment program. Within 48 h of admission to the hospital, participants were administered structured clinical interviews assessing mental health disorders and suicidality. Following these interviews, participants completed self-report questionnaires assessing symptom severity and impulsivity. Consistent with past research, an exploratory factor analysis of our 90-item impulsivity instrument resulted in a three-factor solution: Pervasive Influence of Feelings, Feelings Trigger Action, and Lack of Follow-Through. Concurrent analysis of these factors confirmed hypotheses of unique associations with suicide ideation and attempts in the past month. Specifically, whereas Pervasive Influence of Feelings (i.e., tendency for emotions to shape thoughts about the self and the future) is uniquely associated with greater suicidal ideation, Feelings Trigger Action (i.e., impulsive behavioral reactivity to emotions) is uniquely associated with the occurrence of suicide attempts, even after controlling for current psychiatric diagnoses and symptoms. Exploratory gender analyses revealed that these effects were significant in female but not male adolescents. These findings provide new insight about how specific domains of impulsivity differentially increase risk for suicide ideation and attempts. Implications for early identification and prevention of youth suicide are discussed.     

The Role of Family Functioning in Bipolar Disorder in Families

Investigated the association between family functioning and conflict and their links with mood disorder in parents and with children's risk for bipolar disorder. Participants were 272 families with a child between the ages of 5-17 years. Parents' history of psychiatric diagnoses and children's current diagnoses were obtained via semi-structured interviews. Parent report on the Family Assessment Device and the Conflict Behavior Questionnaire measured family functioning and conflict, respectively. Results revealed a small but significant indirect pathway from parental diagnosis of mood disorder to child bipolar disorder through impaired family functioning, via increased family conflict. Parental mood disorders were also significantly related to other negative outcomes in children, including unipolar depression and oppositional defiant disorder. Associations between parent diagnoses and family functioning changed depending on youth age, but not youth sex.     

Posttraumatic Stress Disorder and Emotion‐Focused Coping Among Disaster Mental Health Counselors

The authors surveyed 235 disaster mental health counselors (DMHCs) for levels of posttraumatic stress disorder (PTSD) symptom severity. A correlational design was used to examine the roles of adult attachment security, emotion regulation, and mindfulness in predicting PTSD symptoms among this group. Each of the 3 predictors was negatively correlated with PTSD symptom severity, and data supported a mediating role for emotion regulation. Results may inform DMHCs, other counselors, and individuals who train or deploy DMHCs.     

The Role of the Family in the Course and Treatment of Bipolar Disorder

ABSTRACT— Bipolar disorder is a highly recurrent and debilitating illness. Research has implicated the role of psychosocial stressors, including high expressed-emotion (EE) attitudes among family members, in the relapse–remission course of the disorder. This article explores the developmental pathways by which EE attitudes originate and predict relapses of bipolar disorder. Levels of EE are correlated with the illness attributions of caregivers and bidirectional patterns of interaction between caregivers and patients during the postepisode period. Although the primary treatments for bipolar disorder are pharmacological, adjunctive psychosocial interventions have additive effects in relapse prevention. Randomized controlled trials demonstrate that the combination of family-focused therapy (FFT) and pharmacotherapy delays relapses and reduces symptom severity among patients followed over the course of 1 to 2 years. The effectiveness of FFT in delaying recurrences among adolescents with bipolar disorder and in delaying the initial onset of the illness among at-risk children is currently being investigated.     

多巴胺对动物冲动性的影响

冲动性是注意缺陷障碍、物质成瘾以及病理性赌博等常见精神疾病的主要症状, 已经成为人们日益关注的焦点。研究发现, 前额叶–纹状体神经回路多巴胺参与了冲动性的调节, 但是研究结果并不一致, 多巴胺在冲动性中发挥的作用, 可能会受到三个不同因素的影响。首先, 冲动性具有多维度特征, 多巴胺对冲动的多种亚结构的作用存在差异; 其次, 多巴胺可以通过多个脑区以及与其他递质系统的交互作用影响冲动性; 最后, 多巴胺在调节冲动性的过程中可能还受到多种变量的影响, 如个体差异、环境线索等。     

The Comorbidity of Post-traumatic Stress Disorder and Suicidality in Vietnam Veterans

Vietnam veterans (N = 232) recruited from three sources were assessed for suicidal thinking and behaviors, and symptoms of posttraumatic stress disorder (PTSD) and depression. Findings support the notion that suicidal thoughts are prevalent in this group, with veterans in psychotherapy reporting a greater likelihood of such symptoms (82.6%) than veterans in the community (35.7%) or those seeking assistance through a veteran's outreach center (66.7%). Thoughts of ending one's life and a previous suicide attempt were significantly correlated with a diagnosis of PTSD (r = .53, p < .001; and r = .33, p < .001, respectively). Veterans with a diagnosis of PTSD and depression or dysthymia were also more likely to report suicidal thinking and behaviors than veterans with only one of the diagnoses.     

Emotion‐Based Learning is Biased by Brand Logos

Although decision making has historically been regarded as a cold and rational process, recent research has suggested that emotional factors are actually quite central to this fundamental process. By using a modified version of the Iowa gambling task, we measured how such brands impact decision making. Participants were asked firstly to rate their liking/loyalty towards numerous brands. Some of these rated brands were later superimposed onto the card decks in a subsequent Iowa gambling task. Results demonstrate that an individual's decision making is altered depending on the congruency between brand valence (liked/not) and the deck reward structure. This bias was sometimes advantageous and led to faster and more accurate decisions. From an applied perspective, the study suggests several ways in which brands can either enhance or inhibit new product success. More broadly, the research demonstrates a seemingly irrational effect of brands on behaviour. Copyright © 2012 John Wiley & Sons, Ltd.     

Identifying and Addressing Barriers to Treatment Decision‐making in Bipolar II Disorder: Clinicians’ Perspective

Objective

Treatment decision‐making in bipolar II disorder is complex due to limited evidence on treatment efficacy and potentially burdensome side‐effects of options. Thus, involving patients and negotiating treatment options with them is necessary to ensure that final treatment decisions balance both clinician and patient preferences. This study qualitatively explored clinician views on (a) effective treatment decision‐making, unmet patient needs for (b) decision‐support and (c) information.

Method

Qualitative semi‐structured interviews with 20 practising clinicians (n = 10 clinical psychologists, n = 6 general practitioners, n = 4 psychiatrists) with experience treating adult outpatients with bipolar II disorder were conducted. Interviews were audiotaped, transcribed verbatim and analysed thematically using framework methods. Self‐report professional experience, and clinician preferences for patient decision‐making involvement were also assessed.

Results

Qualitative analyses yielded two inter‐related themes: (a) challenges and barriers to decision‐making and (b) facilitators of clinician decision‐making. Symptom severity, negative family attitudes, system‐based factors, and information gaps were thought to pose challenges to decision‐making. By contrast, decision‐making was supported by patient information, family involvement and patient‐centredness, and a strong therapeutic relationship. Clinician views varied depending on their professional background (medical vs clinical psychologist), patient involvement preferences, and whether the clinician was a bipolar specialist.

Conclusions

Whilst clinicians uniformly recognise the importance of involving patients in informed treatment decision‐making, active patient participation is hampered by unmet informational and decision‐support needs. Current findings inform a number of bipolar II disorder‐specific, clinician‐endorsed strategies for facilitating patient decision‐making, which can inform the development of targeted patient decision‐support resources for use in this setting.     

The Scarlet Letter of Mental Illness: De-stigmatizing Bipolar Disorder

This article is written from the perspective of one who has Bipolar Disorder. It focuses on misunderstandings of Bipolar Disorder, on the fact that it is the person who has the disorder who is most affected by it, and on the struggles but also the benefits of having this and other disorders. It calls upon educators to challenge the stigmas associated with mental illness, noting that while statistically the majority of people suffer from milder forms of Bipolar, the most extreme forms and symptoms of the disorder are popularized as the norm. Such misunderstandings not only cause people to be unfairly stigmatized, but also result in faulty mainstream diagnostic criteria that screen out people with milder forms of the disorder, keeping them from getting treatment.     

Impulsivity and emotion dysregulation in Borderline Personality Disorder

This study examined the association of borderline personality disorder (BPD) and negative emotional states with impulsivity in the laboratory. Undergraduate participants who were high in BPD features (high-BPD; n = 39) and controls who were low in BPD features (low-BPD; n = 56) completed measures of negative emotional state before a laboratory measure of impulsivity--a passive avoidance learning task. Controlling for psychopathology, high-BPD participants committed a greater number of impulsive responses than did low-BPD participants. Negative emotional state moderated the effect of BPD on impulsive responses. High-BPD participants who were in a negative emotional state committed fewer impulsive responses than high-BPD participants who were low in negative emotional state. Fear, nervousness, and shame negatively correlated with impulsivity among high-BPD participants but not among low-BPD participants. In addition, high-BPD participants reported greater emotion dysregulation in a variety of domains, compared with low-BPD participants.     

The Effects of Cell Phone Use and Emotion‐regulation Style on College Students' Learning

Cell phones are becoming an inevitable part of the classroom, but extant research suggests that using cell phones in the classroom impairs academic performance. The present study examined the impact of different cell phone policies on learning and emotion‐regulation style. Participants were randomly assigned to one of four experimental conditions: cell phone usage allowed, cell phone possession allowed but without usage, cell phones removed, and a no‐instruction control group. All participants watched a 20‐minute lecture and were sent text messages to mimic classroom distractions. Afterward, participants took a multiple‐choice test and filled out questionnaires assessing their level of obsessiveness, nomophobia, and mindfulness. Participants who had their cell phone taken away performed best on the test with no other differences. None of the emotional‐regulation measures moderated the results. These findings provide important insight as to how cell phone policies can optimize learning in the classroom.Copyright © 2017 John Wiley & Sons, Ltd.     

The Role of Depression, Shame-Proneness, and Guilt-Proneness in Predicting Criticism of Relatives Towards People With Bipolar Disorder

Expressed emotion (EE) has been associated with poor patient outcomes in many different psychiatric disorders. Given its robust association with relapse, EE has become a major target of family psychoeducational interventions. Most psychoeducational interventions to date have failed to change EE levels among families of those with bipolar disorder. Better intervention strategies, then, may depend on an increased understanding of the predictors of EE. Although EE has traditionally included many facets, criticism appears to be the most robust predictor of outcome within bipolar disorder. The present study tested three primary predictors of criticism among family members of people with bipolar disorder: shame-proneness, guilt-proneness, and depression. Depressive symptoms were significantly associated with EE. Discussion focuses on limitations and implications of the study and suggestions for future research.     

On the Iatrogenic Risk of Assessing Suicidality: A Meta‐Analysis

Previous studies have failed to detect an iatrogenic effect of assessing suicidality. However, the perception that asking about suicide may induce suicidality persists. This meta‐analysis quantitatively synthesized research concerning the iatrogenic risks of assessing suicidality. This review included studies that explicitly evaluated the iatrogenic effects of assessing suicidality via prospective research methods. Thirteen articles were identified that met inclusion criteria. Evaluation of the pooled effect of assessing suicidality with regard to negative outcomes did not demonstrate significant iatrogenic effects. Our findings support the appropriateness of universal screening for suicidality, and should allay fears that assessing suicidality is harmful.     

Attentional Processing of Threat in Bipolar Disorder: Going Beyond Mood-Congruency

Emotional processing in bipolar disorder (BD) entails a complex attentional pattern not merely restricted to happy or sad biases, but also directed towards threatening information. This study examined threat-related bias on attentional orienting when participants were not instructed about the presentation of emotional stimuli (i.e., implicit instructions). An emotional dot-probe task in which an emotional face (i.e., threat, sad, happy) is simultaneously displayed with a neutral face was applied to BD individuals in their different episodes: mania (n?=?26), depression (n?=?24), and euthymia (n?=?28) as well as to a group of healthy controls (n?=?28). Symptomatic BD patients (i.e., in a manic or depressive episode) showed an attentional orienting bias toward threatening faces but not for happy or sad faces, while euthymic BD patients did not exhibit any attentional bias for emotional stimuli. A bias toward happy faces was found in the control group. Threat-related bias was not related to the severity of affective and anxiety symptoms in BD. When attention is not explicitly directed to emotional information, threat-related bias may characterize attentional orienting during mania and depression, but may be attenuated during euthymia.

     

Bipolar Disorder and the Family: An Integrative Model

The relationship between major mental illness and the family is complex. This article describes a model that recognizes biological, individual, and familial aspects of illness, and the interaction and reciprocal effects of these different levels. This model is illustrated using the example of bipolar illness, with particular emphasis on the effects of the illness on the family. Many characteristics previously noted in bipolar families can be understood as consequences, rather than causes, of the illness. A framework for integrated treatment is also described.     

Memory in Early Onset Bipolar Disorder and Attention-Deficit/Hyperactivity Disorder: Similarities and Differences

Differentiating between early-onset bipolar disorder (BD) and attention-deficit/hyperactivity disorder (ADHD) can be difficult. Memory problems are commonly reported in BD, and forgetfulness is among the diagnostic criteria for ADHD. We compared children and adolescents with BD (n?=?23), ADHD combined type (ADHD-C; n?=?26), BD?+?ADHD-C (n?=?15), and 68 healthy controls on memory tests (Digit span, Children's Verbal Learning Test-II). Further analyses were performed on subgroups of BD (BD-I, BD-II/BD-NOS, with and without previous psychotic symptoms). All clinical groups demonstrated some problems with free recall, but the BD subgroup with a history of psychotic symptoms had a more pervasive problem that also included recognition and semantic clustering. The ADHD-C groups demonstrated the lowest performance on working memory. These data suggest that children and adolescents with BD and previously psychotic symptoms may have inefficient encoding of verbal material, whereas memory problems in ADHD-C appear more characterized by impaired free recall.