Illness representations in patients with multimorbid long-term conditions: qualitative study

Most research on illness representations explores how patients view single conditions, but many patients report more than one long-term condition (known as multimorbidity). It is not known how multimorbidity impacts on patient illness representations. This exploratory qualitative study examined patients' representations of multimorbid long-term conditions and sought to assess how models of illness representation might need modification in the presence of multimorbidity. We explored two major issues: (1) the impact of multimorbidity on patient representations of their individual conditions and (2) the representation of multimorbidity itself. Twenty eight adults with at least two long-term conditions (mean of 4) were interviewed. The presence of multimorbidity impacted on patient illness representations in relation to the dimensions of identity, perceived cause, coherence and consequences. Representations of multimorbidity itself concerned representations of the burden of medication and perceived priorities among conditions and synergies and antagonisms between conditions and their management. The results have implications for the measurement of multimorbidity (through scales such as the Illness Perception Questionnaire) and the use of illness representations in the design and delivery of interventions to improve health behaviour and outcomes of patients with multiple long-term conditions.     

Substance use and delinquency among adolescents with childhood ADHD: The protective role of parenting

Several domains of parenting have been identified as important for adolescent well-being. Whether these same domains are equally beneficial for adolescents with ADHD histories remains an empirical and clinically important question. This study examined whether parental knowledge of their teen's activities and whereabouts, consistency, support, and parent-adolescent conflict are associated with substance use and delinquency similarly for adolescents with and without a diagnosis of ADHD in childhood. A sample of 242 adolescents, 142 diagnosed with ADHD in childhood and prospectively followed into adolescence, and 100 without ADHD in childhood, were the focus of study. The relations between adolescent-reported outcomes (i.e., substance use and delinquency) and parenting behaviors were tested using latent variable modeling to determine both the effects of general (common) and specific (unique) parenting behaviors for participants with and without a history of ADHD. Adolescents' report of parental knowledge was a significant correlate of delinquency and substance use above and beyond other parenting variables and the variance in common across the parenting variables. More knowledge was associated with less delinquency and substance use for all participants, but parental knowledge was more strongly associated with alcohol use for adolescents with versus without childhood ADHD. These correlational findings suggest that, despite the increased difficulty of parenting youths with ADHD histories, actions taken by parents and youth to increase parental awareness may provide some protection against behavioral transgressions known to be elevated in this population. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Portability of a screener for pediatric bipolar disorder to a diverse setting

Robust screening measures that perform well in different populations could help improve the accuracy of diagnosis of pediatric bipolar disorder. Changes in sampling could influence the performance of items and potentially influence total scores enough to alter the predictive utility of scores. Additionally, creating a brief version of a measure by extracting items from a longer scale might cause differential functioning due to context effects. The authors of current study examined both sampling and context effects of a brief measure of pediatric mania. Caregivers of 813 youths completed the parent-reported version of the General Behavior Inventory (PGBI) at an academic medical center sample enriched for mood disorders. Caregivers of 481 youths completed the PGBI at a community mental health center. Caregivers of 799 youths completed 10 items extracted from the PGBI at a community setting. Caregivers of 159 youths completed both versions of the PGBI and a semistructured diagnostic interview. Differential item functioning indicated that across samples some items functioned differently; however, total observed scores were similar across all levels of mania. Receiver operating characteristic analysis indicated that the 10 extracted items discriminated bipolar disorder from nonbipolar behavior as well as when the items were embedded within the full measure. Findings suggest that the extracted items perform similarly to the embedded items in the community setting. Measurement properties appear sufficiently robust across settings to support clinical applications.     

The psychological costs of painless but recurring experiences of racial discrimination

When studying discrimination, it is important to examine both perceived frequency and stress associated with these experiences, as well as the interplay between these two dimensions. Using data from Latino/a participants (N = 168), we found an interaction effect of the reported frequency and reported stressfulness of discrimination on psychological distress (depression and anxiety), such that frequency predicted greater psychological distress for low-stress events, but high-stress events were associated with greater distress regardless of frequency. In addition, using the constructs of "stated" and "derived" stressfulness, we found that the frequency of experiences of discrimination that were rated as less stressful were, in fact, correlated with greater psychological distress. Discrimination events not experienced as stressful nonetheless may have negative implications for the target, especially if they occur frequently.     

Anxiety and depression and their links with delusions and hallucinations in people with a dual diagnosis of psychosis and substance misuse: a study using data from a randomised controlled trial

Rates of depression and anxiety have been linked to severity and distress associated with positive symptoms in psychosis. There is also tentative evidence to suggest that these concurrent symptoms might be related to delusional and hallucinatory content. Our aim was to assess the cross-sectional associations between anxiety and depression, and hallucination and delusion severity and distress in a sample of 327 people dually diagnosed with psychosis and substance misuse problems. In addition, the relationships between specific symptom content and levels of anxiety and depression were examined. Anxiety was associated with delusion distress and depression with hallucination distress, although neither was related to symptom severity. Auditory commands to harm or kill the self were associated with higher levels of depression. Delusions with themes pertaining to the paranormal, and those with references to celebrities were associated with lower levels of depression. No specific delusion or hallucination content was associated with level of anxiety, when other variables were controlled for. The results demonstrate that anxiety and depression are linked to distinct aspects of psychotic experience, highlighting the need to acknowledge the role of these concurrent symptoms in the context of psychosis. In addition, findings relating to specific types of delusions and hallucinations highlight avenues for further research.     

Antagonistic modulatory influences of negative affect on cognitive control: Reduced and enhanced interference resolution capability after the induction of fear and sadness

The present behavioral study investigated the influence of negative affect on the neural mechanisms of cognitive control. We expected to find evidence for an antagonistic modulation of cognition by threat-relevant and threat-irrelevant negative affect (i.e. fear and sadness) that should promote bottom-up monitoring and top-down selection, respectively. Subjects performed one of three conflict tasks (Stroop, Flanker, or Simon) that tap distinct control mechanisms of conflict resolution, comprising specific attentional and motor control processes. On each task trial, target stimuli were preceded by a face stimulus exhibiting a fearful, sad, or neutral expression, providing three affect conditions. Our data provides strong evidence for substantially increased selection (attentional and motor selection) after priming of threat-irrelevant negative affect (sadness). Deviating from the results of previous studies, our analysis did not consistently yield increased monitoring after fear priming. We discuss these findings with respect to the effectiveness of different experimental affect priming procedures (i.e. stimuli) and the role of the task context, among others.     

End state copying by humans (Homo sapiens): implications for a comparative perspective on cumulative culture

It has been proposed that the uniqueness of human cumulative culture may be attributable to humans' greater orientation toward copying the process of behavior (imitation), as compared with the products (emulation), resulting in particularly high fidelity transmission. Following from previous work indicating that adult human participants can exhibit cumulative learning on the basis of product copying alone, we now investigate whether such learning involves high fidelity transmission. Eighty adult human (Homo sapiens) participants were presented with a task previously shown to elicit cumulative learning under experimental conditions, which involved building a tower from spaghetti and modeling clay. Each participant was shown two completed towers, ostensibly built by previous participants, but actually built to prespecified designs by the experimenter. This end state information was provided either in the form of photographs, or the presence of actual towers. High fidelity matching to these end states was apparent in both demonstration conditions, even for a design that was demonstrably suboptimal with regard to the goal of the task (maximizing tower height). We conclude that, although high fidelity transmission is likely to be implicated in cumulative culture, action copying is not always necessary for this to occur. Furthermore, since chimpanzees apparently copy behavioral processes and well as products, and also transmit behavior with high fidelity, the stark absence of unequivocal examples of cumulative culture in nonhumans may be attributable to factors other than imitative ability.     

Culture and the body: East-West differences in visceral perception

This research investigated cross-cultural differences in the accuracy of individuals' perceptions of internal visceral states. We conducted 4 studies to test the hypothesis that Asians are less sensitive to internal physiological cues relative to European Americans. Studies 1 and 2 assessed cultural differences in visceral perception via tests of misattributions of arousal: Study 1 involved false heart rate feedback during an emotionally evocative slideshow and examined subsequent self-reported affective changes; Study 2 manipulated apparent physiological arousal and measured its effects on attraction via an immersive virtual environment. Study 3 directly assessed visceral perception using a heartbeat detection task. All 3 studies found Asians to be less viscerally perceptive than European Americans. Study 4 examined one possible cultural mechanism for the observed difference and found evidence for contextual dependency as a mediator of the culture-visceral perception link.     

Sub‐Dimensions of the Four Factor Model of Cultural Intelligence: Expanding the Conceptualization and Measurement of Cultural Intelligence

Cultural intelligence (CQ) – the capability to function effectively in intercultural settings – has gained increasing attention from researchers and practitioners due to its contemporary relevance to globalization, international management, and workforce diversification. Research‐to‐date demonstrates that CQ predicts a variety of important outcomes in intercultural contexts, such as cultural adaptation, expatriate performance, global leadership, intercultural negotiation, and multicultural team processes. Moving beyond past research that tends to focus on the four primary factors of CQ – metacognitive CQ, cognitive CQ, motivational CQ, and behavioral CQ, we introduce an expanded conceptualization of CQ that delineates sub‐dimensions for each of the four factors. We briefly review psychometric evidence supporting the proposed second order 11‐factor structure and convergent/discriminant validity of the sub‐dimensions. We propose that the next wave of CQ research should be guided by a deeper understanding of each of four factors of CQ.