Youth with Chronic Pain and Postural Orthostatic Tachycardia Syndrome (POTS): Treatment Mediators of Improvement in Functional Disability

Intensive pain rehabilitation programs are effective in increasing functioning for youth with chronic pain (CP). However, the utility of such programs for youth with CP and co-morbid postural orthostatic tachycardia syndrome (POTS) is rarely examined. In addition, studies examining mediators of treatment for CP are sparse. This paper compares treatment outcomes for youth with CP (n?=?117) and youth with CP?+?POTS (n?=?118). Additionally, depression and pain catastrophizing were tested as potential mediators of treatment effects. Significant treatment improvements were found for functional disability, depression, pain catastrophizing, and perceived pain intensity but with no differences between groups. Improvements in depressed mood, pain catastrophizing (helplessness subscale), and pain severity partially mediated functioning improvement. Pain severity was not a significant mediator in the CP?+?POTS group. We concluded that depression and pain catastrophizing, especially the helplessness domain, can impact functioning improvement in adolescents with CP and POTS and are particularly important to target in treatment.     

Olfactory Reference Syndrome: A Case Report and Screening Tool

Journal of Clinical Psychology in Medical Settings - Olfactory reference syndrome (ORS) is a lesser known disorder that is related to obsessive–compulsive disorder. ORS is the obsessional and...     

D-Cycloserine for Treatment Nonresponders With Obsessive-Compulsive Disorder: A Case Report

Despite being the most effective treatment available, as many as one third of patients who receive exposure and response prevention (ERP) for obsessive-compulsive disorder (OCD) do not initially respond to treatment. Recent research suggests that the n-methyl d-aspartate (NMDA) receptor partial agonist D-Cycloserine (DCS) may speed up the course of ERP for OCD rather than enhance it. Thus, it is unclear whether DCS would benefit patients who have proven nonresponsive to ERP and serotonin reuptake inhibitors. The present study evaluated the ability of DCS to enhance ERP for 2 patients with OCD who previously had failed to show adequate response to treatment using time-series analysis. Both patients experienced greater reductions with DCS augmented ERP than they did with prior treatment; however, 1 patient relapsed by the 1-month follow-up. DCS augmented ERP might be an effective method for boosting outcomes in individuals who do not readily respond to ERP.     

Case Report: Direct Access Genetic Testing and A False-Positive Result For Long QT Syndrome

We report the case of a woman who pursued direct access genetic testing and then presented with concerns regarding a positive test result for Long-QT syndrome. Although the result ultimately proved to be a false positive, this case illustrates that costs associated with follow-up of direct access genetic testing results can be non-trivial for both the patient and for health care systems. Here we raise policy questions regarding the appropriate distribution of these costs. We also discuss the possibility that, when confronted by a direct access genetic test result that reports high risk for one or more actionable diseases, a family physician might feel compelled to act out of a desire to avoid liability, even when information regarding the accuracy and validity of the testing were not easily accessible. This case outlines lessons that can easily be translated into clinical practice, not only by genetic counselors, but also by family physicians, medical specialists and members of the public.     

Successful Treatment of Olfactory Reference Syndrome With Cognitive Behavioral Therapy: A Case Study

Olfactory reference syndrome (ORS) is characterized by a preoccupation with the belief that one's body emits a foul odor. Cognitive behavioral therapy (CBT) was used to treat a woman in her 50s who presented in our outpatient anxiety disorders specialty clinic with ORS, accompanied by embarrassment, shame, distress, avoidance behavior, and social isolation. Monitoring and systematic reduction of safety behaviors, combined with exposure to anxiety-provoking situations, resulted in elimination of the perceived body odor over the course of ten treatment sessions. Scores on the Overvalued Ideas Scale indicated improvements in the client's insight over the course of treatment, and there was an 82.6% reduction in her preoccupation and compulsive behaviors as measured by the Body Dysmorphic Disorder Yale-Brown Obsessive Compulsive Scale. Indices of depression, anxiety, and stress as measured by the 21-item version of the Depression Anxiety Stress Scales were also reduced from the extremely severe to normal range. These findings suggest further investigation of CBT in the treatment of ORS is warranted.     

Pathological Left-Handedness: A Case Report Examining the Developmental Course of the Syndrome Following Head Trauma

The present case study examines, through longitudinal neuropsychological assessment over a time span of 3 years, the course of pathological left-handedness (PLH; Orsini & Satz, 1986; Satz, Soper, & Orsini, 1988; Satz, Orsini, Saslow, & Henry, 1985; Satz, 1973; Soper & Satz, 1984) in a 6-year, 2-month-old female. The case illustrates for the first time, in a data-based and time-delineated fashion, the pattern of changes that have been previously attributed to this syndrome (Satz et al., 1985) including trophic alterations, abrupt shift in manual dominance, and probable interhemispheric reorganization detrimental to visual-spatial functions (crowding hypothesis). Theoretical and applied implications associated with the present findings are also addressed.     

Adapting Mindfulness-based Stress Reduction for the Treatment of Obsessive-compulsive Disorder: A Case Report

Obsessive-compulsive disorder (OCD) is an illness characterized by intrusive and distressing thoughts, images, or impulses (i.e., obsessions) and by repetitive mental or behavioral acts (i.e., compulsions) performed to prevent or reduce distress. Efficacious treatments for OCD include psychotropic medications and exposure and response prevention (EX/RP). The following case report presents an individual diagnosed with OCD who refused treatment with medication or EX/RP and was treated using an adapted Mindfulness-Based Stress Reduction (MBSR) program. After an 8-week adapted MBSR program, the endpoint evaluation revealed clinically significant reductions in symptoms of OCD as well as an increased capacity to evoke a state of mindfulness. Discussion includes generalizability of these findings, potential mechanisms of action, and the role of an adapted MBSR in the treatment of OCD.     

The Assessment and Treatment of Post-Abortion Syndrome: A Systematic Case Study From Southern Africa

This article reports a clinical case study of “Grace”, a black Zimbabwean woman with post-abortion syndrome (PAS), a form of post-traumatic stress disorder precipitated by aborting an unwanted pregnancy. She was treated by a middle class white South African trainee Clinical Psychologist. The case narrative documents the assessment and the course of treatment which was guided by ongoing case formulation based on current evidence-based models. Factors that made her vulnerable to developing PTSD included active suppression of the memory of the event and lack of social support. An understanding of these factors was used to guide an effective intervention. In spite of the differences in culture and background between client and therapist, there was considerable commonality in their experience as young women and students who each had to balance personal and occupational priorities. The narrative also highlights the commonalities of Grace's experiences with those reported in the literature on post-abortion syndrome, which is mostly from the U. S. A. and Europe.     

Parent-Facilitated Behavioral Treatment for Avoidant/Restrictive Food Intake Disorder: A Case Report

Avoidant/restrictive food intake disorder (ARFID), which was introduced in DSM-5, may be one of the most functionally impairing eating disorders, yet little is known regarding risk factors, prevalence, or efficacious treatment models for the disorder. With no empirically supported treatment for ARFID, it is important to investigate the clinical utility of innovative therapeutic approaches. Here we describe a novel parent-facilitated behavioral treatment for youth with ARFID (PBT-ARFID) that is grounded in learning theory, as well as components of well-established family-based treatment (FBT) for eating disorders. We propose a two-factor theory of avoidance learning within a biopsychosocial model to explain behavior in ARFID and utilize counterconditioning as a core intervention to reverse paired, classically conditioned association between food and aversive state (i.e., disgust and/or anxiety). This report details a step-by-step comprehensive treatment approach for ARFID that can be adapted to a broad range of youth and their families, along with a case study illustrating application of the model. This pilot case provides preliminary evidence that the PBT-ARFID model incorporating counterconditioning may be a powerful treatment for youth with ARFID. More case and pilot studies are needed to justify formally investigating its efficacy in a randomized controlled trial.     

The Perception of Teasing Scale (POTS): A Revision and Extension of the Physical Appearance Related Teasing Scale (PARTS)

This article describes the development and validation of a revised measure for the assessment of history of being teased about physical appearance. Study 1 involved the preliminary psychometric evaluation of the questionnaire on a sample of 227 college women, Two factors emerged: Weight-Related Teasing (WT) and Teasing About Abilities/Competencies (Competency Teasing; CT). The integrity of the factor structure of these two scales was established in Study 2 with a sample of 87 college women. Internal consistency ratios in this sample were also found to be acceptable. In Study 3, 92 college women were administered measures of body image, eating disturbance, and self-esteem to test for convergence with the Perception of Teasing Scale. Subjects also rated teasing items for frequency and effect (e.g., how upset they were by the teasing). Two-week test-retest reliabilities for these measures were acceptable. Weight-Related Teasing correlated to a greater degree with other measures than Competency Teasing. Regression analyses revealed the importance of a frequency versus effect dimension. Findings are discussed in light of recent research on developmental factors in body image and eating disturbance.     

Cognitive Behavioral Treatment of Comorbid Anxiety Disorders and Social Difficulties in Children with High-Functioning Autism: A Case Report

A substantial proportion of children with high-functioning autism (HFA) or Asperger syndrome (AS) have one or more comorbid anxiety disorders. Because anxiety disorders exacerbate the social difficulties and other functional impairments caused by an autism spectrum disorder (ASD), there is a need for efficacious treatments to address the clinical needs of youth with this comorbid presentation. This article describes an evidence-based cognitive behavioral therapy (CBT) treatment manual enhanced to address the unique characteristics and clinical needs of children with ASD. A case study is presented in which CBT was utilized in the successful treatment of an 11-year-old girl with HFA. The intervention was effective in reducing anxiety and improving social and adaptive functioning. These findings suggest that an enhanced CBT approach may be a viable intervention for children with comorbid HFA and anxiety disorders that should be further evaluated.     

A Case of Triple X Syndrome Manifesting with the Syndrome of Nonverbal Learning Disabilities

There has been a relative absence of studies that have examined comprehensively the neuropsychological profiles of females with Triple X Syndrome across a battery of tests and measures. A case is reported of a 9 1/2-year-old female with Triple X Syndrome whose neuropsychological test results were suggestive of greater right- versus left-cerebral hemisphere dysfunction. Overall, the patient's neuropsychological profile was indicative of the syndrome of Nonverbal Learning Disabilities (NLD) as proposed by Rourke (Rourke 1987, 1988, 1995; Rourke & Tsatsanis, 1996). The results are discussed in light of Rourke's NLD Syndrome and the related white matter model.     

Psychological Intervention in a Case of Bulimia Nervosa: A Case Report

This paper presents a case report detailing the use of an enhanced form of enhanced cognitive behavior therapy (CBT) and other techniques that were employed when faced with impediments in adhering to manualized CBT-E. Ms. S, 22 years old unmarried female pursuing MBBS final year, belonging to upper middle socioeconomic status and urban domicile was provided with 28 weekly sessions of psychotherapy to simultaneously address the patient’s symptoms and try to effect change across multiple domains. A single case design was adopted. Therapy was conducted over 9 months. A total of 28 sessions were taken, with the frequency of two sessions/week initially, and then moving onto one session/week. Pre and Post assessments using Binge Eating Scale, BDI-II, height and weight measurements and frequency of binging episodes using visual analogue scale were done. On measures of pre and post assessment there was 87 % improvement in Binging Episodes, 82 % improvement on Binge Eating Scale and client had 3 kg weight gain with reduction in depression as assessed on BDI-II. The gains were maintained at 1 month follow up. The use and deviations from CBT E, therapy process, role of family and challenges to intervention will be discussed in this case report.     

Treatment of Insomnia within an Interdisciplinary Pain Rehabilitation Program: A Randomized Trial

Background/ObjectivePrior research indicates interdisciplinary pain rehabilitation program (IPRP) usual care (UC) does not sufficiently address sleep problems among individuals with comorbid chronic pain and clinical levels of insomnia. Cognitive behavioral therapy for insomnia (CBT-I) is an evidence-based insomnia intervention. The current study investigates the translation of CBT-I into an IPRP.MethodIn this single-site, prospective, randomized controlled pilot study, insomnia and pain-related outcomes were examined for adults participating in a 10-week IPRP (N = 79) who were allocated to a 4-session group-based CBT-I (IPRP+CBT-I) or usual care (IPRP-UC) condition.ResultsPatients in the IPRP+CBT-I group showed improvements in insomnia symptoms at the end compared to the beginning of the CBT-I group; however, there were no IPRP outcome differences relative to the IPRP-UC condition. Both groups reported statistically significant reductions in insomnia, pain severity, pain-related life interference, and depressed mood. Fewer than one-third of participants reported clinically meaningful reductions in insomnia symptoms following IPRP participation.ConclusionsFurther efforts are needed to address sleep problems in pain rehabilitation settings.     

Profiles of Naturalistic Attentional Trajectories Associated with Internalizing Behaviors in School-Age Children: A Mobile Eye Tracking Study

Research on Child and Adolescent Psychopathology - The temperament profile Behavioral Inhibition (BI) is a strong predictor of internalizing behaviors in childhood. Patterns of attention towards or...     

The Perception of Teasing Scale (POTS): a revision and extension of the Physical Appearance Related Teasing Scale (PARTS)

This article describes the development and validation of a revised measure for the assessment of history of being teased about physical appearance. Study 1 involved the preliminary psychometric evaluation of the questionnaire on a sample of 227 college women, Two factors emerged: Weight-Related Teasing (WT) and Teasing About Abilities/Competencies (Competency Teasing; CT). The integrity of the factor structure of these two scales was established in Study 2 with a sample of 87 college women. Internal consistency ratios in this sample were also found to be acceptable. In Study 3, 92 college women were administered measures of body image, eating disturbance, and self-esteem to test for convergence with the Perception of Teasing Scale. Subjects also rated teasing items for frequency and effect (e.g., how upset they were by the teasing). Two-week test-retest reliabilities for these measures were acceptable. Weight-Related Teasing correlated to a greater degree with other measures than Competency Teasing. Regression analyses revealed the importance of a frequency versus effect dimension. Findings are discussed in light of recent research on developmental factors in body image and eating disturbance.     

Treatment of Maternal Depression With In-Home Cognitive Behavioral Therapy Augmented by a Parenting Enhancement: A Case Report

Depression is prevalent among mothers who participate in home visitation programs. This case study describes In-Home Cognitive Behavioral Therapy (IH-CBT), an empirically based treatment for depressed mothers that is strongly integrated with ongoing home visitation. The use of a Parenting Enhancement for Maternal Depression (PEMD) module was added to address parenting difficulties in a depressed mother. This case describes issues and challenges encountered in delivering treatment in the home with low-income, depressed mothers. Issues involving engagement, adaptation to the setting, responding to the unique needs of low-income mothers, and partnership with concurrent home visiting to optimize outcomes are considered. Long-term follow-up (18 months after the end of treatment) permits examination of sustainability of gains. Implications for treating this high-risk population are discussed.     

Psychobiological Treatment Response to a Two-Week Posttraumatic Stress Disorder and Mild Traumatic Brain Injury Integrated Treatment Program: A Case Report

Posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) demonstrate high prevalence and comorbidity among post-9/11 veterans. Veterans with this comorbidity often present with multiple co-occurring healthcare needs and increased clinical complexity. The current case report describes the clinical presentation of a veteran with mild TBI and PTSD, both before, during, and after treatment within a multidisciplinary 2-week intensive outpatient program involving prolonged exposure, evidence-based PTSD treatment, and Cognitive Symptom Management and Rehabilitation Therapy, evidence-based treatment for postconcussive symptoms. Mr. A was a 25-year-old White, transgender male who presented with a complex mental health history. At intake, presenting complaints included anxiety, panic attacks, nightmares, and depression secondary to military sexual trauma, as well as reported cognitive difficulties secondary to a concussion. He met current criteria for PTSD as well as panic disorder with agoraphobia. Head injury history consisted of a motor vehicle collision with less than 30 seconds loss of consciousness, brief posttraumatic amnesia, and alterations of consciousness. Mr. A demonstrated habituation during individual exposure sessions as assessed via skin conductance during imaginal exposures and decreased subjective ratings during in vivo exposures, as well as a decrease in trauma-potentiated startle response to trauma cues. Posttreatment data indicates significant reduction in neurobehavioral, posttraumatic stress, and depression symptoms and significant improvement in subjective cognitive functioning. The current findings support the feasibility and efficacy of short-term integrated treatment for complex clinical presentations and the need for larger scale research investigating combined PTSD and TBI intervention.