Who are the comorbid adolescents? Agreement between psychiatric diagnosis,youth, parent,and teacher report

The investigators examined the rates of psychiatric comorbidity for externalizing and internalizing behavior problems, using semistructured diagnostic interview and parent, teacher, and youth report on the Achenbach checklists. The study also evaluated the effects of conjunctive, compensatory, and disjunctive data combination strategies. Using the same data and identical diagnostic thresholds, between 5 and 74% of 189 youths presenting to an outpatient clinic were identified as having comorbid internalizing and externalizing problems. Parent report and semistructured interview indicated the highest comorbidity rates. Despite good cross-source agreement (rs .29–.58), there was very little agreement about which specific youths presented with comorbid internalizing and externalizing problems (kappas .14–.40). Results also indicate that single DSM-IV disorders, such as bipolar disorder, can manifest comorbid patterns of behavior problems on checklists.     

More than the Terrible Twos: The Nature and Severity of Behavior Problems in Clinic-Referred Preschool Children

The primary goals of this study are to describe the nature and severity of disruptive behavior problems in clinic-referred preschoolers from low-income environments and to explore the validity of DSM-IV disruptive disorders for young children. We examine the relation between DSM-IV symptoms, standardized behavior checklists, and observational ratings as a means of exploring measurement validity in this age group. Seventy-nine clinic-referred preschoolers (ages 2 through 5 years) from low-income environments were assessed. To examine whether clinic-referred preschool children have symptoms that are consistent with DSM-IV disruptive behavior disorders, parents were administered a semistructured diagnostic interview, modified for developmentally appropriate usage. In addition, parents completed the Child Behavior Checklist (CBCL) and children's behavior problems were assessed with observational ratings during parent–child interaction. Nearly half of the sample met criteria for conduct disorder, and three quarters met criteria for oppositional defiant disorder. Preliminary evidence for the validity of DSM-IV disruptive disorders in preschool children was demonstrated through association with CBCL scores, behavior ratings, and significant levels of impairment. Future efforts aimed at validating these diagnoses in preschoolers and implications for prevention are discussed.     

Role of Reward Sensitivity and Processing in Major Depressive and Bipolar Spectrum Disorders

Since Costello’s (1972) seminal Behavior Therapy article on loss of reinforcers or reinforcer effectiveness in depression, the role of reward sensitivity and processing in both depression and bipolar disorder has become a central area of investigation. In this article, we review the evidence for a model of reward sensitivity in mood disorders, with unipolar depression characterized by reward hyposensitivity and bipolar disorders by reward hypersensitivity. We address whether aberrant reward sensitivity and processing are correlates of, mood-independent traits of, vulnerabilities for, and/or predictors of the course of depression and bipolar spectrum disorders, covering evidence from self-report, behavioral, neurophysiological, and neural levels of analysis. We conclude that substantial evidence documents that blunted reward sensitivity and processing are involved in unipolar depression and heightened reward sensitivity and processing are characteristic of hypomania/mania. We further conclude that aberrant reward sensitivity has a trait component, but more research is needed to clearly demonstrate that reward hyposensitivity and hypersensitivity are vulnerabilities for depression and bipolar disorder, respectively. Moreover, additional research is needed to determine whether bipolar depression is similar to unipolar depression and characterized by reward hyposensitivity, or whether like bipolar hypomania/mania, it involves reward hypersensitivity.     

Exploring Behavioral Activation and Inhibition Sensitivities Among College Students at Risk for Bipolar Spectrum Symptomatology

We explored cross-sectionally the roles in bipolar spectrum symptomatology of two broad motivational systems that are thought to control levels of responsiveness to cues of threat and reward, the Behavioral Inhibition System (BIS) and the Behavioral Activation System (BAS). Undergraduate students (n = 357) completed questionnaires regarding (a) bipolar spectrum disorders [the General Behavior Inventory (GBI), a well-established clinical screening measure], (b) current depression and mania symptoms (the Internal State Scale; ISS), and (c) BIS/BAS sensitivities (the BIS/BAS scales). Validated cutoff scores on the GBI were used to identify individuals at risk for a mood disorder. It was hypothesized that, among at-risk respondents, high BAS and low BIS levels would be associated with high current mania ratings, whereas low BAS and high BIS would be associated with high current depression ratings. Multiple regression analyses indicated that, among at-risk individuals (n = 63), BAS accounted for 27% of current mania symptoms but BIS did not contribute. For these individuals, BAS and BIS were both significant and together accounted for 44% of current depressive symptoms.     

Cerebral laterality and depression: differences in perceptual asymmetry among diagnostic subtypes

Examined the influence of diagnostic subtype of depression on perceptual asymmetry for dichotic listening and visual tachistoscopic tasks. A total of 65 unmedicated patients with major depressive disorders and 30 normal controls were tested on a verbal and nonverbal task in each modality. Patients diagnosed according to the DSM-III with melancholia had abnormal perceptual asymmetry for dichotic nonsense syllable and complex tone tasks. In contrast, patients having a nonmelancholic "atypical depression" (reactivity of mood with preserved pleasure capacity and associated features) did not differ from normal controls on these tasks, but had an increased incidence of left handedness. Bipolar depression (history of hypomania) differed from unipolar depression in showing abnormal perceptual asymmetry for a tachistoscopic dot enumeration task. Alterations of perceptual asymmetry in melancholia and bipolar depression were consistent with hypothesized right hemisphere dysfunction.     

Role of Parenting and Maltreatment Histories in Unipolar and Bipolar Mood Disorders: Mediation by Cognitive Vulnerability to Depression

In this article, we review empirical research on the role of individuals' parenting and maltreatment histories as developmental antecedents for symptoms and diagnosable episodes of unipolar and bipolar spectrum disorders. Our review is focused on the following three overarching questions: (1) Do negative parenting and a history of maltreatment contribute risk to symptoms or diagnosable episodes of unipolar and bipolar disorders? (2) Are the associations of negative parenting and maltreatment histories with bipolar disorders similar to those for unipolar depression? and (3) Are the associations between negative parenting and maltreatment histories and unipolar and bipolar symptoms or disorders mediated by cognitive vulnerability to depression? We begin by discussing the methodological requirements for demonstrating a psychosocial risk factor and the methodological issues that plague the parenting and maltreatment literatures. Next, we review the extant studies on the role of parenting histories in unipolar and bipolar disorders. We consider the specificity and possible moderators of the parenting-mood disorder relationship, as well as cognitive vulnerability to depression as a mediator of this relationship. Then, we review studies on the association of maltreatment histories with unipolar and bipolar disorders and the role of cognitive vulnerability to depression as a mediator of this association. We conclude with an assessment of the state of the parenting and maltreatment literatures in unipolar and bipolar disorder with regard to our guiding questions.     

Cognitive responses to failure and success relate uniquely to bipolar depression versus mania

This project examined cognitive responses to failure and success and their association with depression and mania within bipolar disorder. Many cognitive variables that are associated with unipolar depression have been found to be involved in bipolar disorder, more specifically bipolar depression. This research was the first to examine tendencies to hold high standards, engage in self-criticism, and generalize from failure to an overall sense of self-worth. In Study 1, undergraduates were screened for risk of mood disorders and completed structured diagnostic interviews. History of bipolar spectrum disorders and history of depression had separate associations with negative generalization. The association of generalization with bipolar spectrum disorders was accounted for by current depressive symptoms. For Study 2, the authors developed a measure of the tendency to engage in positive generalization following success experiences. In a sample of 276 undergraduates, this measure related uniquely to risk for mania. Results of these 2 studies suggest that responses to failure are associated with a history of depression, whereas responses to success are associated with a risk for mania. Implications for future research and clinical work are discussed.     

Self-criticism,interpersonal conditions,and biosystemic inflammation in suicidal thoughts and behaviors within mood disorders: A bio-cognitive-interpersonal hypothesis

We review the theoretical and empirical literature on the role of self-concept in suicidal behavior in the context of mood disorders (i.e., unipolar depression and bipolar spectrum disorders). The main themes emanating from this review are then juxtaposed against (a) the Interpersonal-Psychological Theory of Suicide and (b) biological research on the role of inflammatory processes in suicidality. Such a juxtaposition paves the way for a bio-cognitive-interpersonal hypothesis. Pathologies of the self-concept—primarily self-criticism—propel mood disorder sufferers to generate interpersonal stress that culminates in two proximal causes of suicidality: thwarted belongingness and perceived burdensomeness. In turn, these two interpersonal conditions set in motion systemic biosystemic inflammation, serving as a proximal cause for suicidality in mood disorders. We conclude by describing a research project aimed at testing this hypothesis, and by outlining pertinent implications for assessment, treatment, and prevention.     

General behavior inventory identification of unipolar and bipolar affective conditions in a nonclinical university population

Validated the General Behavior Inventory (GBI), revised to identify unipolar as well as bipolar affective conditions, in a nonclinical sample (n = 201) against naive, interview-derived diagnoses. For bipolar and unipolar conditions, respectively, the GBI had high positive (.94, .87) and negative (.99, .93) predictive power with the effect of prevalence considered, adequate sensitivity (.78, .76), high specificity (.99, .99), and adequate selection ratios for sampling of affective and nonaffective subjects from nonclinical populations for research purposes. The utility of the GBI in several different research contexts is discussed.     

Prospective Longitudinal Associations Between Persistent Sleep Problems in Childhood and Anxiety and Depression Disorders in Adulthood

The objective of this study was to examine the associations between persistent childhood sleep problems and adulthood anxiety and depression. Parents of 943 children (52% male) participating in the Dunedin Multidisciplinary Health and Development Study provided information on their childrens sleep and internalizing problems at ages 5, 7, and 9 years. When the participants were 21 and 26 years, adult anxiety and depression were diagnosed using a standardized diagnostic interview. After controlling for childhood internalizing problems, sex, and socioeconomic status, persistent sleep problems in childhood predicted adulthood anxiety disorders (OR (95% CI) = 1.60 (1.05–2.45), p = .030) but not depressive disorders (OR (95% CI) = .99 (.63–1.56), p = .959). Persistent sleep problems in childhood may be an early risk indicator of anxiety in adulthood.     

Induced mood change and dysfunctional attitudes in remitted bipolar I affective disorder

This study investigated the possibility that, in remitted bipolar I affective disorder, dysfunctional attitudes are mood-state dependent. Participants were 120 individuals with remitted bipolar I disorder, remitted unipolar depression, or no history of affective disorder. The Dysfunctional Attitudes Scale (DAS; Weissman, 1979) was completed before and after positive or negative mood challenge. Following mood increase, the bipolar group changed significantly less in DAS total score than did the other 2 groups, and in goal-striving and achievement attitudes relative to the unipolar group. These findings did not provide clear support for the mood-state dependency theory in bipolar disorder, arguing instead for the presence in bipolar I disorder of dysfunctional cognitions that show characteristic resilience in the face of minor positive mood increase.     

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.     

Parent–Child Interaction Therapy and Chronic Illness: A Case Study

We examined the outcome of parent–child interaction therapy (PCIT) for a child diagnosed with Oppositional Defiant Disorder (ODD) and cancer. Robert, a 4-year-old Caucasian male, showed significant and meaningful changes in his behavior over the course of 13 weeks of PCIT, and Robert no longer met diagnostic criteria for ODD following treatment. His scores on the Eyberg Child Behavior Inventory and the Achenbach Child Behavior Checklist were in the clinical range before treatment and in the normal range at the conclusion of treatment. His mother also reported dramatic improvements in Robert's behavior during medical visits. Physician and social worker reports were consistent with her report. Such anecdotal data may have implications for the generalization of compliance to the medical setting for children with chronic illnesses. The results of this case study should prompt further investigation of parent-training interventions for children with chronic illnesses and disruptive behavior.     

Dimensionality of the Beck Youth Inventories With Child Psychiatric Outpatients

The Anxiety, Depression, Anger, Disruptive Behavior, and Self-Concept Inventories of the Beck Youth Inventories of Emotional and Social Impairment (J. S. Beck, A. S. Beck, & J. Jolly, 2001) were administered to 150 female and 150 male outpatients who were 7–12 years old and matched by sex as to whether they were diagnosed with anxiety, mood, adjustment, or attention-deficit and disruptive behavior disorders to determine whether each inventory represented distinct symptom dimensions. Horns parallel analyses (J. L. Horn, 1965) found that the Anxiety, Depression, and Disruptive Behavior Inventories were unidimensional, but that the Anger and Self-Concept Inventories were each composed of two underlying dimensions. Iterated principal-factor analyses indicated that the Anger Inventory represented Affective and Cognitive dimensions, whereas the Self-concept Inventory reflected Self-Esteem and Competency dimensions. However, the overall pattern of results was discussed as supporting the current practice of scoring each inventory as a summative scale for clinical assessment purposes.     

Personality Assessment Inventory (PAI) Profiles of Male Veterans With Combat-Related Posttraumatic Stress Disorder

The Personality Assessment Inventory (PAI; L. C. Morey, 1991) is a promising tool for the assessment of Posttraumatic Stress Disorder (PTSD), but few studies have examined the PAI profiles of individuals with the diagnosis. In this study, the PAI was administered to 176 combat veterans with PTSD. Results showed significant elevations on scales measuring depression, somatic complaints, anxiety, anxiety-related disorders, schizophrenia, and negative impression management. The Traumatic Stress subscale was the highest point in the mean score profile and was moderately correlated with several established measures of PTSD. Veterans with and without comorbid major depression differed on PAI scales assessing depression, anxiety, and warmth. Analysis of two-point codetypes for the PAI and the MMPI-2 revealed substantial heterogeneity in symptom endorsement on both instruments, suggesting that there may be no clear PTSD profile on either instrument. Results provide a reference point for future work with the PAI in PTSD samples.     

Behavioral Approach System (BAS) Sensitivity and Bipolar Spectrum Disorders: A Retrospective and Concurrent Behavioral High-Risk Design

In this article, we tested the vulnerability hypothesis of the behavioral approach system (BAS) hypersensitivity model of bipolar disorders. We examined whether self-reported BAS sensitivity predicts lifetime bipolar spectrum diagnoses as well as symptoms and personality characteristics associated with bipolar disorder using a retrospective and concurrent behavioral high-risk design. Participants with high (HBAS; n=28) or moderate (MBAS; n=24) BAS sensitivity were selected and given a lifetime psychiatric diagnostic interview and self-report measures of proneness to bipolar symptoms, current symptoms, and personality characteristics relevant to bipolarity. HBAS participants were significantly and substantially more likely to have a lifetime bipolar spectrum disorder diagnosis than were MBAS participants, but did not differ from MBAS participants in their likelihood of a unipolar depression diagnosis. Also, the HBAS group exhibited higher impulsivity and proneness to hypomanic symptoms than the MBAS group, and BAS-reward responsiveness predicted hypomanic personality characteristics. Finally, high behavioral inhibition system (BIS) sensitivity was associated with proneness to and current depressive symptoms.

Perimenopausal mental disorders: epidemiology and phenomenology

Perimenopause, the interval of irregular menstrual activity which directly precedes menopause, is characterized by widely fluctuating hormone levels amidst a large-scale decline in circulating estrogen. This phase in a woman's life is typically accompanied by physical discomforts including vasomotor symptoms, such as headaches, insomnia, and hot flushes, as well as genital atrophy. Not surprisingly, studies suggest a significant increase in mood lability for women during this time. While some evidence points toward an exacerbation of bipolar mood symptoms and an increase in schizophrenic psychosis during perimenopause, the majority of research conducted on perimenopausal mental disorders has focused on unipolar depression. Studies vary widely in methodology, definitions of menopausal status, and degrees of depression among subjects; however, the majority of findings indicate an increased susceptibility to depression during the perimenopausal transition. This greater susceptibility may be due to neuroendocrine effects of declining estrogen levels, the subjective experience of somatic symptoms resulting from this hormonal decline, and/or the more frequent occurrence of "exit" or "loss" events for women during this stage of life. At this time, more research is needed to address questions of prevalence, risk, and etiology for depression and other major mental disorders as related to the physiological and psychosocial changes associated with perimenopause.     

Evaluative communications between affectively Ill and well mothers and their children

Earlier research suggests that the natural verbal discourse of mothers with their children can be important in clarifying, verifying, and evaluating the behavior in which a child is engaged, in attributing qualities to the child, and in influencing the child's self-perceptions. We investigated the potential influences of parental affective illness (bipolar affective disorder and unipolar depression in contrast to no history of psychiatric illness) on such labeling behavior in a sample of 61 mothers and their older (school-age) and younger (preschool-age) children. It was hypothesized that the dispositions characterizing affective illness (specifically, negativity and disengagement) would be reflected in the labeling statements of mothers with a diagnosis as they interacted with their children. Based on videotaped interactions during a visit to a home-like laboratory apartment, labeling statements were identified in terms of speaker and person being labeled (addressee) and coded (positive, negative, mixed, or neutral) for judgmental and affective quality of the statement and reaction of the addressee. Data were analyzed (a) by family unit and (b) my mother to child statements. The general pattern of findings indicated, in relative terms, an excess of negativity on the part of family members in the bipolar group and a dearth of negative affect for mothers in the unipolar group. Negativity in the bipolar group appeared to be especially likely when the setting involved mothers and two male children. Additionally, findings are discussed in terms of sex differences in vulnerability to depression.This work was supported by the National Institute of Mental Health, Bethesda, Maryland, and by the John D. and Catherine T. MacArthur Foundation Research Network on Transition from Infancy to Early Childhood. Appreciation is extended to Nancy Lemos and Marcella Maguire for coding the data. National Institute of Mental Health, Building 15K, 9000 Rockville Pike, Bethesda, Maryland 20892.     

An Examination of PAI Clinical Descriptors and Correlates in an Outpatient Sample: Tailoring of Interpretive Statements

The Personality Assessment Inventory (PAI; Morey 1991, 2007) was designed to evaluate patterns of psychopathology utilizing validity, clinical, treatment, and interpersonal scales. Its psychometric strengths include easily read items, gradations of responses, and extensive validation. The primary focus of the current study is to examine item-level clinical correlates to inform interpretation. For external validity, the Psychiatric Diagnostic Screening Questionnaire (PDSQ; Zimmerman 2002) was utilized by examining individual items and subscales. The investigation used archival data from 192 outpatients. The most specific and detailed clinical correlates were found for PAI mood disorder scales. Several other clinical scales, such as Schizophrenia (SCZ), had comparatively few clinical correlates. The current findings underscore the need to further validate PAI external correlates in order to augment PAI statements.     

Linking Informant Discrepancies to Observed Variations in Young Children’s Disruptive Behavior

Prior work has not tested the basic theoretical notion that informant discrepancies in reports of children’s behavior exist, in part, because different informants observe children’s behavior in different settings. We examined patterns of observed preschool disruptive behavior across varying social contexts in the laboratory and whether they related to parent-teacher rating discrepancies of disruptive behavior in a sample of 327 preschoolers. Observed disruptive behavior was assessed with a lab-based developmentally sensitive diagnostic observation paradigm that assesses disruptive behavior across three interactions with the child with parent and examiner. Latent class analysis identified four patterns of disruptive behavior: (a) low across parent and examiner contexts, (b) high with parent only, (c) high with examiner only, and (d) high with parent and examiner. Observed disruptive behavior specific to the parent and examiner contexts were uniquely related to parent-identified and teacher-identified disruptive behavior, respectively. Further, observed disruptive behavior across both parent and examiner contexts was associated with disruptive behavior as identified by both informants. Links between observed behavior and informant discrepancies were not explained by child impairment or observed problematic parenting. Findings provide the first laboratory-based support for the Attribution Bias Context Model (De Los Reyes and Kazdin Psychological Bulletin 131:483–509, 2005), which posits that informant discrepancies are indicative of cross-contextual variability in children’s behavior and informants’ perspectives on this behavior. These findings have important implications for clinical assessment, treatment outcomes, and developmental psychopathology research.