Irritability in Children and Adolescents With OCD

Irritability is a common, impairing transdiagnostic symptom in childhood psychopathology, though it has not been comprehensively studied in pediatric obsessive-compulsive disorder (OCD). Further, the central cognitive behavioral treatment component for OCD, exposure and response prevention therapy (ERP), has been recently proposed as a treatment for irritability. This study aimed to evaluate whether certain clinical characteristics are associated with irritability in pediatric OCD and whether irritability reduces following ERP. Participants were 161 youth (ages 7–17) with OCD and a caregiver participating in a randomized controlled trial of D-cycloserine or pill placebo augmented ERP. Participants completed validated assessments during treatment. Irritability was significantly and positively associated with depressive symptoms, defiance, functional impairment, and family accommodation, but was not associated with pretreatment OCD severity, symptom dimensions, obsessive beliefs. Irritability significantly declined following treatment, with over half of youth with any pretreatment irritability experiencing clinically significant change, though this change was not related to OCD improvement. Results suggest that irritability may be a marker of psychiatric comorbidity, parental accommodation, and impairment in youth with OCD. Implications for the exposure-based treatment of irritability are discussed.     

Group Leader-Recorder Relationship in a State Hospital: A Learning Tool

The process group for staff and trainees in institutional settings has become increasingly unpopular as a resource, although ironically, the need for such a group has grown. The author presents the idea that the process group is not used more often because of a general lack of understanding of the nature of such groups as well as a failure to clearly distinguish process groups from traditional psychotherapy groups. The author goes on to give a clear definition of the task and the boundaries of a process group and, using knowledge of systems thinking, discusses special techniques for running such groups with illustrative examples.     

A Practicum of Group Psychotherapy by Asya L. Kadis,Jack D. Kramer,Charles Winick,and S. H. Foulkes

The dwelling on personally significant past experiences, reminiscence, is a common phenomenon, particularly among the elderly. This paper explores the potential value associated with the use of reminiscence in group psychotherapy, particularly with elderly populations. After reviewing the various functions (both adaptive and maladaptive) that reminiscence could serve in geriatric group therapy, the paper presents specific guidelines toward maximizing its therapeutic value.     

Assessing readiness for change in adolescents with eating disorders

The Readiness and Motivation Interview (RMI) is a semistructured interview measure of readiness and motivation to change that can be used for all eating disorder diagnoses. The RMI has demonstrated excellent psychometric properties and has both clinical and predictive utility in adult samples. This study examined the psychometric properties of the RMI in a younger population, namely, 12- to 18-year-old girls with eating disorders. Study participants (N = 65) completed the RMI and measures of convergent, discriminant, and criterion validity. Adolescents with eating disorders were able to conceptualize and articulate their readiness for change and to report the extent to which change efforts were for themselves versus for others. RMI readiness profiles across eating disorder symptom domains in adolescents were comparable to those in adults, with higher reported readiness to change binge eating than to change dietary restriction or compensatory strategies. Differences in internal consistency between adult and adolescent samples are discussed. Interviewing adolescents early in treatment about readiness may assist clinicians in forming an alliance with this difficult-to-engage population, while also providing valuable information for treatment planning.     

Temporal associative processes revealed by intrusions in paired-associate recall

Although much is known about the factors that influence the acquisition and retention of individual paired associates, the existence of temporally defined associations spanning multiple pairs has not been demonstrated. We report two experiments in which subjects studied randomly paired nouns for a subsequent cued recall test. When subjects recalled nontarget items, their intrusions tended to come from nearby pairs. This across-pair contiguity effect was graded, spanning noncontiguously studied word pairs. The existence of such long-range temporally defined associations lends further support to contextual-retrieval models of episodic association.     

Touchscreen-enhanced visual learning in rats.

The efficiency of traditional levers and of modern touchscreen technology for training rats on a computerized visual discrimination was studied in a series of observations. When compared with a lever-based discrimination procedure, the use of touchscreens supported the faster development of signal tracking behavior and acquisition of a two-stimulus simultaneous visual discrimination. It did not affect the final level of accuracy. Factors related to spatial proximity of the responses with the stimuli, sign-tracking, and increased ease of touchscreen motor responses were suggested as possible reasons for the touchscreen training advantage. This increased efficiency allows large numbers of animals to be tested quickly, a necessary requirement for studies involving genetic and physiological interventions.     

Toward a Model Informed Consent Process for BRCA1 Testing: A Qualitative Assessment of Women's Attitudes

As an initial part of a project to develop a model informed consent process for BRCA1 testing, we conducted a series of focus groups. At the groups, women initially expressed great interest in testing, but their interest diminished after learning more. If offered testing, women would most want to learn about test accuracy, practical details of testing, and management options if the result was positive. Perceived benefits of testing included gaining information leading to risk reduction, relief of uncertainty, more responsible parenting, and assisting in research. Perceived risks included the discomfort and cost of the testing process itself, and anxiety after a positive result. The risk of possible insurance discrimination was rarely mentioned spontaneously. Many women would want their providers to make recommendations, rather than be nondirective about testing. We observed that women vary greatly in their informational and counseling needs, and suggest that the informed consent process should be individualized, taking into account a woman's perception and her preferences for how testing decisions should be made.