Early-Onset Bipolar Spectrum Disorders: Diagnostic Issues

Since the mid 1990s, early-onset bipolar spectrum disorders (BPSDs) have received increased attention in both the popular press and scholarly press. Rates of diagnosis of BPSD in children and adolescents have increased in inpatient, outpatient, and primary care settings. BPSDs remain difficult to diagnose, particularly in youth. The current diagnostic system makes few modifications to accommodate children and adolescents. Researchers in this area have developed specific BPSD definitions that affect the generalizability of their findings to all youth with BPSD. Despite knowledge gains from the research, BPSDs are still difficult to diagnose because clinicians must: (1) consider the impact of the child’s developmental level on symptom presentation (e.g., normative behavior prevalence, environmental limitations on youth behavior, pubertal status, irritability, symptom duration); (2) weigh associated impairment and course of illness (e.g., neurocognitive functioning, failing to meet full DSM criteria, future impairment); and (3) make decisions about appropriate assessment (differentiating BPSD from medical illnesses, medications, drug use, or other psychiatric diagnoses that might better account for symptoms; comorbid disorders; informant characteristics and assessment measures to use). Research findings concerning these challenges and relevant recommendations are offered. Areas for further research to guide clinicians’ assessment of children with early-onset BPSD are highlighted. Principal Investigators and Coinvestigators of Longitudinal Assessment of Manic Symptoms (LAMS) Group are listed in Appendix.     

H.R.成人成套神经心理测验在我国的修订

本文是修订Halstead—Reitan成套神经心理测验(H·R·B)成人本的总结。从15个省市取样,正常组885名,脑病组350例。根据测验结果按性别和年龄制定了各分测验的划界分,按划界分计算了两组受试的损伤指数(DQ)。并制定了脑病损的诊断和定侧的标准。按此标准对样本病人进行了脑损伤的诊断和定侧。诊断符合率为80.3％,右侧病损的符合率为70.8％,左侧为45.7％。分测验的重则相关系数分别为0.93—0.39。     

Perceptions of mothers: Effects of employment status,marital status,and age of child

Ninety-six female and 96 male college students evaluated a briefly described adult female stimulus person on 24 7-point bipolar scales that described personality traits and professional performance characteristics. Each subject rated 1 of 8 mothers, who was described as either employed or nonemployed, either divorced or married, and as having either a 1-year-old or 11-year-old child. Employed mothers were viewed as less family oriented, but as more instrumental than nonemployed mothers. Divorced mothers were perceived as less well adjusted but more instrumental than married mothers. Employed mothers with a 1-year-old child were rated as most professionally competent, while employed mothers with an 11-year-old child were rated as most instrumental.Portions of this paper were presented at the meeting of the Midwestern Psychological Association, Chicago, May 1987.     

试论反应性抑郁形成的心理过程

对反应性抑郁形成的心理过程进行解释的理论中 ,较有影响的有精神分析理论、控制理论、认知理论、自我注意理论和行为主义理论。由于这些理论都仅强调某一个因素的作用 ,因而有一定的局限性。如果综合考虑这些因素 ,同时还考虑到评价、个体扮演角色的多少及其采用的应付方式等因素的作用 ,就可以看出反应性抑郁形成的完整心理过程。     

4—11岁儿童数学概念稳定性的发展的研究

设计了四组试验项目,每组3或5个难度不同的项目,在掩盖操作和不掩盖操作条件下分别检查儿童数、长度、面积、体积等概念的稳定性。全国13个地区每地区以“临床法”个别试验4—6岁儿童每年龄组30人,或7—11岁儿童每年龄组20—30人。总的结果初步表明:儿童数学概念的稳定性随年龄而发展,表现于解答课题的成绩和解答过程的认知水平两个方面。数学概念稳定性的发展因课题的类型和难易而异其先后。数学稳定性在不掩盖操作条件下表现高于在掩盖操作条件下。在不掩盖操作演示的启发下,掩盖操作条件下的成绩有提高。这两者都是在相应数学概念正处于发展中的阶段比较明显。在文化条件相等的情况下未发现儿童数学概念稳定性的民族差异和性别差异。儿童数学概念稳定性发展的顺序似乎是数、长度、面积、体积。作者认为,数学概念从不稳定到稳定有一个发展过程;稳定性本身不是绝对的,而是有条件的,并非出现于特定的年龄。     

The Impact of First-Grade “Friendship Group” Experiences on Child Social Outcomes in the Fast Track Program

Many interventions for childrens behavior problems successfully utilize a group format for social skills training, providing opportunities for practice and performance feedback from peers. Recent studies however, suggest that grouping aggressive children together may reduce intervention effectiveness or even increase risk. The present study examined the relative impact of childrens own behavior and their experiences with peers in the first-grade friendship groups of Fast Track, a multi-component preventive intervention program. Two-hundred sixty-six children (56% minority, 29% female) participated in 55 friendship groups. Childrens own positive and negative behavior in friendship groups was related to relative improvements in social cognitive skills, prosocial behavior, and aggression, assessed through child interviews, teacher ratings, and peer sociometric nominations. Results from hierarchical linear models also revealed that the amount of peer escalation children received for their disruptive behavior during sessions impeded some intervention gains, whereas mere exposure to other childrens positive or negative behavior was rarely related to outcomes.Members of the Conduct Problems Prevention Research Group are, in alphabetical order, Karen L. Bierman, Pennsylvania State University; John D. Coie, Duke University; Kenneth A. Dodge, Duke University; E. Michael Foster, Pennsylvania State University; Mark T. Greenberg, Pennsylvania State University; John E. Lochman, University of Alabama; Robert J. McMahon, University of Washington; and Ellen E. Pinderhughes, Tufts University     

Differential effects of manual assisted cognitive behavior therapy in the treatment of recurrent deliberate self-harm and personality disturbance: the POPMACT study

A total of 480 patients were treated in a large, multicenter randomized trial of a brief form of cognitive therapy, manual-assisted cognitive behavior therapy (MACT) versus treatment as usual (TAU) for recurrent deliberate self-harm. Each patient was randomized after a self-harm episode assessed at an accident and emergency center and followed up over 1 year. The main hypothesis tested was that those allocated to MACT would have a lower proportion of self-harm episodes in the succeeding year. A total of 60% of those allocated to MACT had face-to-face treatment and 430 (90%) of all patients had self-harm data recorded after 1 year. Although the results showed no significant difference between those repeating self-harm in the MACT group (39%) compared with the TAU group (46%) (P = 0.20), the treatment was cost effective (10% cheaper than TAU) and the frequency of self-harm episodes was fewer (50%) in the MACT group. A total of nine of 10 patients had some personality disturbance (42% of these with disorder), and for those where information on parasuicide events was collected, the proportion having a repeat episode ranged from 33% to 63% for different personality disorders. Those with BPD were most likely to repeat episodes quickly (mean 89 days for 25% to repeat) with dissocial personality disorder (equivalent mean 384 days) the slowest to repeat. Total costs were significantly greater in those with personality disorder and were reduced in those allocated to MACT; this saving was reversed in those with borderline disorder. On average, MACT appeared to increase the cost of those patients with BPD (BPD) and reduce the cost of those with other personality disorders. It is concluded that MACT has value in preventing self-harm cost effectively but this appears to be confined mainly to those who do not have BPD.     

Psychometric validation of the Obsessive Beliefs Questionnaire and the Interpretation of Intrusions Inventory: Part I

This article reports on the validation of the Obsessive Beliefs Questionnaire (OBQ) and Interpretations of Intrusions Inventory (III) developed by the Obsessive Compulsive Cognitions Working Group (OCCWG) to assess the primary beliefs and appraisals considered critical to the pathogenesis of obsessions. A battery of questionnaires that assessed symptoms of anxiety, depression, obsessive-compulsive symptoms and worry was administered to 248 outpatients with a DSM-IV diagnosis of Obsessive-Compulsive Disorder (OCD), 105 non-obsessional anxious patients, 87 non-clinical adults from the community, and 291 undergraduate students. Tests of internal consistency and test-retest reliability indicated that the OBQ and III assessed stable aspects of OC-related thinking. Between-group differences and correlations with existing measures of OC symptoms indicated that the OBQ and III assess core cognitive features of obsessionality. However, the various subscales of the OBQ and III are highly correlated, and both measures evidenced low discriminant validity. The findings are discussed in terms of the relevance and specificity of cognitive constructs like responsibility, control and importance of thoughts, overestimated threat, tolerance of uncertainty and perfectionism for OCD.