Metabolic and endocrine disturbances in psychiatric disorders: a multidisciplinary approach to appropriate atypical antipsychotic utilization

Patients with psychiatric disorders have an increased rate of cardiovascular morbidity and mortality compared with the general population. Metabolic issues such as weight gain, dyslipidemia, diabetes mellitus, diabetic ketoacidosis,and pancreatitis have been reported with the use of antipsychotic agents. Although atypical antipsychotics have not been linked directly to the development of metabolic syndrome, these medications have been shown to increase risk factors that can lead to metabolic and endocrine disturbances. Therefore, clinicians should provide ongoing monitoring for patients who are being treated for psychiatric disorders with these agents. According to the 2004 Consensus Report on Antipsychotics, screening measures should include baseline and follow-up monitoring of personal/family histories, weight (body mass index), waist circumference, blood pressure, fasting plasma glucose, and fasting lipid profile.     

Empirical and conceptual problems with longitudinal trait-state models: introducing a trait-state-occasion model

The latent trait-state-error model (TSE) and the latent state-trait model with autoregression (LST-AR) represent creative structural equation methods for examining the longitudinal structure of psychological constructs. Application of these models has been somewhat limited by empirical or conceptual problems. In the present study, Monte Carlo analysis revealed that TSE models tend to generate improper solutions when N is too small, when waves are too few, and when occasion factor stability is either too large or too small. Mathematical analysis of the LST-AR model revealed its limitation to constructs that become more highly auto-correlated over time. The trait-state-occasion model has fewer empirical problems than does the TSE model and is more broadly applicable than is the LST-AR model.     

A laboratory school comparison of mixed amphetamine salts extended release (Adderall XR) and atomoxetine (Strattera) in school-aged children with attention deficit/hyperactivity disorder

Mixed amphetamine salts extended release (MAS XR; Adderall XR) and atomoxetine (Strattera) were compared in children 6 to 12 years old with attention deficit/hyperactivity disorder (ADHD) combined or hyperactive/impulsive type in a randomized, double-blind, multicenter, parallel-group, forced-dose-escalation laboratory school study. Primary efficacy measure was the SKAMP (Swanson, Kotkin, Agler, M-Flynn, and Pelham) behavioral rating scale. Changes in mean SKAMP deportment scores from baseline were significantly greater for MAS XR (n = 102) than for atomoxetine (n = 101) overall (-0.56 and -0.13, respectively; p < .0001) and at each week (p < .001). Adverse events were similar for both treatment groups. The extended time course of action and greater therapeutic efficacy of MAS XR suggests that it is more effective than atomoxetine in children with ADHD.     

Implementation of a comprehensive schoolwide behavioral intervention: The ABC program

The Academic and Behavioral Competencies (ABC) Program, a schoolwide program to reduce classroom disruption and encourage rule following, academic task completion, and homework completion, is described. The program was initially developed and implemented in an elementary school with a high-risk population. Data from teachers, parents, and children indicate high levels of satisfaction with the program. In addition, unobtrusive measures of program impact, reported as reductions in referrals to the principal's office, suspensions, and increases in homework completion rates relative to the year prior to implementation of the program, suggest a preliminary positive impact of the program. A replication is reported for another school district, with teacher evaluations of satisfaction and effectiveness reported, supporting the flexibility and adaptability of the program. Although the present article does not constitute a systematic evaluation of the ABC Program, it presents preliminary data on the process of implementation and stakeholder satisfaction.     

Optimizing treatment of schizophrenia. Enhancing affective/cognitive and depressive functioning

Recognition and treatment of schizophrenia has largely focused on positive symptoms of the disorder, such as delusions, hallucinations, and disorganization. However, other important symptoms, such as depression, cognition, and social functioning, have not received comparable attention. Fifty percent of schizophrenic patients suffer from comorbid depression, which is a major risk factor for suicide in this population, while 10% to 25% suffer from comorbid obsessive-compulsive disorder. Cognitive deficits commonly observed in patients with schizophrenia include problems with concentration, attention, and memory, as well as problem-solving and verbal skills. These deficits are observed at early stages of the illness and can predict deficits in functional capabilities, such as occupational and social skills, educational attainment, and the ability to live independently. The severity of such impairments affects all patient in this population, including up to 10% of patients working full time and up to one third of those working part time. In light of the debilitating effects of depression, cognitive impairment, and other aspects of affective functioning on the quality of life of patients with schizophrenia, physicians need to partner with their patients to address these concerns and determine an appropriate treatment regimen. This can be done with simple functional-based cognitive questioning, the use of evidence-based psychosocial practices, and psychoeducation on the many pharmacotherapeutic options. It is recommended that depressive or suicidal symptoms of schizophrenia be treated with an antidepressant or mood stabilizer only if the symptoms have not subsided after treatment of the psychosis with an atypical antipsychotic. Additionally, relative to older medications, atypicals have demonstrated benefit in improving some of the cognitive impairments.     

From philosopher to psychologist: the early career of Edwin Ray Guthrie, Jr

Edwin R. Guthrie rose to prominence as a psychologist in the 1930s. His theoretical outlook was behavioristic. This approach came from his conviction that an objective method could be applied to a scientific treatment of mind. Prior to becoming a psychologist, he was a philosopher of mathematics. Guthrie was initiated into psychology by Stevenson Smith, from whom he learned a psychology of adjustment informed by comparative research, Columbia functionalism, and clinical psychology. Guthrie's first step into psychology was in collaboration with Smith on Chapters in General Psychology (S. Smith & E.R. Guthrie, 1921). To synthesize their own unique position on learning from the contemporary theory and research, they used the principle of association. This articles focuses on Guthrie's origin and his development into a learning theorist.     

Protective Factors as Moderators of Risk Factors in Adolescence Bullying

The present study examined the role played by protective factors in moderating the effects of risk factors over bullying and victimization in a sample of 679 male adolescents recruited in Italian high schools. Boys’ involvement in bullying revealed that one in three students has bullied others at least sometimes in the previous three months, and one in six has been victimized at the same rate; victimization decreases with age. The family related risk factor (conflicting parents) was positively associated with bullying and with victimization (together with punitive parenting); the same applied for risk factor related to the individual ways of dealing with problems (emotionally oriented coping skills). Protective factors related to the family context (supportive and authoritative parents) and to the individual (problem solving coping skills) were negatively associated to bullying and victimization. Hierarchical regression analyses revealed a moderating effect of supportive parenting on punitive parenting and on emotionally oriented coping strategies in predicting victimization. Problem solving coping strategies helped buffer the negative impact of emotionally oriented coping strategies over bullying. Implications of results for practitioners and for future studies are addressed.