The PANDAS subgroup: recognition and treatment

A subgroup of patients with childhood-onset obsessive-compulsive disorder (OCD) has been identified who share a common clinical course characterized by dramatic symptom exacerbations following Group A beta-hemolytic streptococcal (GABHS) infections. The term PANDAS has been applied to the subgroup, to indicate the postulated etiology of their symptoms: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections. Five clinical characteristics define the PANDAS subgroup: presence of OCD and/or tic disorder, prepubertal symptom onset, sudden onset or abrupt exacerbations (sawtooth course), association with neurological abnormalities (presence of adventitious movements or motoric hyperactivity during exacerbations), and temporal association between symptom exacerbations and GABHS infections. Post-streptococcal symptom exacerbations are typically quite dramatic, with patients reporting that their symptoms "...came on overnight" or "...appeared all of a sudden a few days after I had a sore throat." The post-streptococcal inflammatory nature of the neuropsychiatric symptoms provides novel opportunities for treatment and prevention, including immunomodulatory therapies such as therapeutic plasma exchange (TPE) and intravenous immunoglobulin (IVIG). A recently completed placebo-controlled trial revealed that both IVIG and TPE were effective in reducing neuropsychiatric symptom severity (40% to 55% reductions, respectively) for a group of severely ill children with OCD and/or tic disorders. Further research is required to determine why the treatments are helpful, as well as to ascertain whether or not antibiotic prophylaxis can help prevent post-streptococcal symptom exacerbations.     

Community Implementation of MI-Enhanced Behavior Therapy for Adolescent ADHD: Linking Fidelity to Effectiveness

Evidence-based behavior therapy for adolescent ADHD faces implementation challenges in real-world settings. The purpose of this trial was to investigate the relationship between implementation fidelity and outcomes among adolescents receiving services in the active treatment arm (N = 114; Motivational Interviewing [MI]-enhanced parent-teen behavior therapy) of a community-based randomized trial of adolescent ADHD treatment. Participants received therapy from community clinicians (N = 44) at four agencies in a large, ethnically diverse metropolitan setting. Therapists provided self-report of session-by-session adherence to content fidelity checklists and audio recordings of sample sessions that were coded for MI integrity. Parents provided report of ADHD symptoms and family impairment at baseline, posttreatment, and follow-up, while academic records were obtained directly from the local school district. Results indicated that content fidelity significantly waned across the 10 manualized sessions (d = -1.23); these trends were steepest when therapy was delivered outside the office-setting and parent attendance was low. Community therapist self-report of content fidelity predicted significantly greater improvements in academic impairment from baseline to follow-up. MI delivery quality was not associated with improved outcomes; contrary to hypotheses, lower MI relational scores predicted significantly greater improvements in family impairment over time. Findings indicate that community-based outcomes for evidence-based ADHD treatment are enhanced when treatment is implemented with fidelity. Future work should revise community-based implementation strategies for adolescent ADHD treatment to prevent declines in fidelity over time, thereby improving outcomes.     

Sublexical and syntactic processing during reading: evidence from eye movements of typically developing and dyslexic readers*

Skilled, typically developing readers and children with dyslexia read correct sentences and sentences that contained verb errors that were pseudo-homophones, morphological over-regularisations or syntactic errors. All errors increased looking time but the nature of the error and participant group influenced the time course of the effects. The pseudo-homophone effect was significant in all eye-movement measures for adults (N?=?26), intermediate (N?=?37) and novice typically developing readers (N?=?38). This effect was larger for intermediate readers than other groups in total duration. In contrast, morphological over-regularisations increased gaze and total duration (but not first fixation) for intermediate and novice readers, and only total duration for adult readers. Syntactic errors only increased total duration. Children with dyslexia (N?=?19) demonstrated smaller effects of pseudo-homophones and over-regularisations than controls, but their processing of syntactic errors was similar. We conclude that dyslexic children's difficulties with reading are linked to overreliance on phonological decoding and underspecified morphological processing, which impacts on word level reading. We highlight that the findings fit well within the grain-size model of word reading [Grainger, J., &; Ziegler, J. C. (2011). A dual-route approach to orthographic processing. Frontiers in Psychology, 2, 54. doi:10.3389/fpsyg.2011.00054].     

To go or not to go? Pupillometry elucidates inhibitory mechanisms in motor imagery

Motor imagery (MI) involves consciously performing an action in our minds without engaging in overt physical movement. Although inhibition is crucial to MI, few studies have explored the nature of inhibitory mechanisms underlying this construct. Therefore, little progress has been made in elucidating how or when inhibition is implemented during MI. The present study addressed this unresolved issue by measuring participants’ pupil dilation (an index of attentional effort) as they performed an inhibitory-control (Go/NoGo) procedure in a modified task-switching paradigm. The results showed that inhibitory mechanisms in MI may be implemented via various routes. When MI was the only movement mode used, minimal attentional effort was invested during the Go/NoGo responses, suggesting an early implemented, proactive inhibitory strategy. Conversely, when imagery was preceded by physical movement responses, inhibition required greater attentional effort and it appears as though more active and attention-demanding inhibitory processes must be employed.     

The role of social support,being present and self-kindness in university student well-being

Poor well-being in university students is a serious concern. Using self-kindness – an attitude of understanding and benevolence in times of adversity or failure – may be key to enabling students to maintain well-being despite the pressures inherent to their student role. This study aimed to test a theoretically guided model of how self-kindness, along with the ability to be in the present moment and the experience of receiving social support, contribute to well-being in university students. Participants were 6195 university students who completed a web-based survey. Structural equation modelling analyses confirmed our hypotheses, showing that: (a) receiving social support is important to the capacity for self-kindness both directly and indirectly through the ability to ‘be present’; and (b) the relationship between social support and well-being is partially mediated by the practices of self-kindness and being present. Overall, the model explained 39% of the variance in student well-being. These findings have implications for our understanding of well-being in university students, as well as the importance of considering self-kindness, on its own, as a target for intervention.     

An Emotion Regulation Treatment for Young People With Complex Substance Use and Mental Health Issues: A Case-Series Analysis

Individuals accessing treatment within the youth alcohol and other drug (AoD) sector represent a highly vulnerable population who present with complex patterns of substance use and mental health comorbidity. Current treatments often fail to address this complexity. Emotion regulation (ER) has been identified as a promising transdiagnostic treatment target for this population of young people. The current study aimed to investigate the acceptability and feasibility of an adjunct ER intervention, ERIC (Emotion Regulation and Impulse Control) in young people receiving AoD treatment at a residential rehabilitation service. A mixed methods case series design was utilized. Ten participants aged between 16–20 years old completed 4–6 sessions of ERIC as an adjunct to their existing residential treatment. Participants undertook a post intervention feedback session and completed a number of self-report measures of ER, depression and anxiety at baseline and 2 weeks after receiving ERIC. Qualitative feedback from young people following the delivery of ERIC was positive, and suggested that ERIC was a viable and useful intervention. Participants reported that the components of ERIC, which involved metaphors and experiential exercises, were particularly beneficial and memorable. Pre-post measures indicated that 60% of the young people had both reliable and clinically significant reductions in overall emotion dysregulation, while reliable and clinically significant reductions in depression and anxiety were observed in 50% and 60% of participants respectively. Results support the acceptability of ERIC for this cohort of young people with complex substance use and mental health needs. Furthermore, these findings support the viability of delivering flexible and adjunctive ER treatments to young people seeking AoD treatment.     

Mood effects on attentional control: a preregistered replication study and critical analysis

In a widely cited paper, Jefferies et al. (2008) report a study in which they manipulated participants’ mood and examined the effects of this manipulation on their performance on the Attentional Blink task. Their results revealed an interaction between emotional valence and arousal: attentional control of participants who experienced a negative mood with low arousal (i.e. sadness) was best, whereas it was worst for participants who experienced a negative mood with high arousal (i.e. anxiety). Performance for participants who were in a positive mood, either with low arousal (i.e. calmness) or high arousal (i.e. happiness) had intermediate scores. In this study, I examined the replicability of this effect and performed additional analyses to investigate the extent to which this effect is due to perceptual or attentional processes and to examine the role of distraction on AB performance. Importantly, the results showed that the crucial interaction between emotional valence and arousal did not reach significance. This could be due a diversity of factors that are addressed in the discussion.     

Balint groups in undergraduate medical education: a systematic review

Objective: Though Balint groups feature increasingly in UK medical school curricula, there is no evidence-based consensus on what undergraduates might gain from participation, and how this might happen. To address this, we systematically reviewed primary research studies involving medical student Balint groups and their relationship with patient-centredness, using narrative synthesis. Data sources: Four major databases were searched from origin until 9 September 2016. The Journal of the Balint Society was hand-searched from 1971 until 9 September 2016. Study selection: English language studies reporting quantitative and/or qualitative methods examining Balint groups in medical students vs. other/no comparator. Results: Eight studies were included. Quantitative findings report statistically significant improvements to student’s empathy and intellectual interest following group participation vs. control (p = 0.03, p = 0.046, respectively). Discussion content was similar across high-income countries. There was considerable heterogeneity when students rated the efficacy of groups. All evidence had high or unclear risk of bias, or was of medium/low quality. Conclusion: Balint groups might help medical students to become more patient-centred, by increasing students’ empathic abilities and supporting their personal and professional growth. Groups are more subjectively effective when optional rather than compulsory. Discussion content is comparable to groups in continuing medical education.     

Racial and Sexual Objectification of Asian American Women: Associations with Trauma Symptomatology,Body Image Concerns,and Disordered Eating

ABSTRACT

Sexism and racism often imbue Asian American women’s socialization experiences. Operating from an objectification theory framework, the present article (a) examines the conceptual relevance of racial and sexual objectification in describing Asian American women’s oppressive experiences, (b) reviews empirical studies linking racial and sexual objectification with Asian American women’s mental health issues, specifically in the areas of trauma symptomatology, body image concerns, and disordered eating, (c) offers critiques of existing research and points to directions for future research, and (d) discusses clinical implications for therapy work with Asian American women based on available literature. In essence, the present review highlights how Asian American women may experience body image concerns, disordered eating, and trauma symptomatology through processes ethnoculturally and socioculturally distinct to them via experiences of racial and sexual objectification. This review calls for a more nuanced and precise understanding of Asian American women’s racial and sexual objectification experiences and associated mental health difficulties. This understanding can only occur through increased empirical research and clinical practice, as informed by feminist scholarship situated in a culturally expanded objectification framework.