Reducing Psychotropic Medications in an Intensive Residential Treatment Center

Medication rates in behaviorally disordered children and youth have greatly increased to current high levels and are very controversial. This study examined changes in psychotropic medication use, levels of behavioral disturbance, and use of personal restraint and seclusion in a population of youth with serious behavioral disorders receiving medically directed cognitive-behavioral treatment in an intensive residential setting. The hypothesis was that there would be significant reductions in medication rates, without the unintended consequences of increased rates of problem behavior or offsetting increases in the use of seclusion or personal restraint. Results showed significant reductions in both the number of youth on medication and the average number of psychotropic medications during the residential stay. There were also significant reductions in behavioral disturbance, seclusions, and personal restraints. These results demonstrate that psychotropic medication can be significantly reduced without increases in problem behavior or the use of seclusions or personal restraints. We conclude that it is possible to significantly reduce psychotropic medication rates to far more conservative levels within the context of a clinically directed cognitive-behavioral treatment milieu.     

Promoting Inclusive Environments: In-group Organizational Endorsement as a Tool to Increase Feelings of Identity-Safety among Black Women

Sex Roles - Black women face unique and harmful biases because of their intersecting and multiple marginalized identities, which are different from those experienced by Black men and White women...     

Do Childhood Externalizing Disorders Predict Adult Depression? A Meta-Analysis

Childhood externalizing disorders have been linked to adult affective disorders, although some studies fail to substantiate this finding. Multiple longitudinal cohort studies identifying childhood psychopathology and their association with adult psychiatric illness have been published. To examine the association between childhood externalizing symptoms or disorders and the development of adult depression across cohorts, a meta-analysis was performed. Potential studies were identified using a PubMed search through November 2013. All published, prospective, longitudinal, community-sampled cohort studies of children (≤ 13 years) with externalizing symptoms or disorders (aggression, conduct problems, oppositional defiant disorder, conduct disorder), reassessed in adulthood (≥ 18 years) for depressive disorders (major depressive disorder, depressive disorder NOS, or dysthymic disorder) were included. A random effects model was used to summarize the pooled effect sizes. Ancillary analyses considered covariates that could account for variance among studies. Ten studies representing eight cohorts of children initially assessed at age 13 or younger (N?=?17,712) were included in the meta-analysis. Childhood externalizing behavior was associated with adult depressive disorders (OR?=?1.52, 95 % confidence interval?=?1.27–1.80, p?相似文献   

Cultural determinants of status: Implications for workplace evaluations and behaviors

Status is a valued workplace resource that facilitates career success, yet little is known regarding whether and how cultural orientation affects status attainment. We integrate status characteristics theory with the literature on individualism and collectivism and propose a cultural patterning in the determinants of status. Four studies (N = 379) demonstrate that cultural orientation influences the tendency to view high status individuals as competent versus warm (Study 1), uncover cultural differences in both individuals’ tendency to engage in competence and warmth behaviors to attain workplace status (Study 2) and evaluators’ tendency to ascribe status to individuals who demonstrate competence versus warmth (Study 3), and verify that cultural differences in the effects of competence and warmth on status perceptions, and in turn performance evaluations, generalize to real world interdependent groups (Study 4). Our findings advance theory on the cultural contingencies of status attainment and have implications for managing diversity at work.     

Children's Coping in the Context of Disasters and Terrorism

Disasters and terrorism present significant and often overwhelming challenges for children and families worldwide. Individual, family, and social factors influence disaster reactions and the diverse ways in which children cope. This article links conceptualizations of stress and coping to empirical knowledge of children's disaster reactions, identifies limitations in our current understanding, and suggests areas for future study of disaster coping. Coping strategies, developmental trajectories influencing coping, and the interplay between parent and child coping represent critical areas for advancing the field and for informing programs and services that benefit children's preparedness and foster resilience in the face of mass trauma.     

Time-varying decision boundaries: insights from optimality analysis

The most widely used account of decision-making proposes that people choose between alternatives by accumulating evidence in favor of each alternative until this evidence reaches a decision boundary. It is frequently assumed that this decision boundary stays constant during a decision, depending on the evidence collected but not on time. Recent experimental and theoretical work has challenged this assumption, showing that constant decision boundaries are, in some circumstances, sub-optimal. We introduce a theoretical model that facilitates identification of the optimal decision boundaries under a wide range of conditions. Time-varying optimal decision boundaries for our model are a result only of uncertainty over the difficulty of each trial and do not require decision deadlines or costs associated with collecting evidence, as assumed by previous authors. Furthermore, the shape of optimal decision boundaries depends on the difficulties of different decisions. When some trials are very difficult, optimal boundaries decrease with time, but for tasks that only include a mixture of easy and medium difficulty trials, the optimal boundaries increase or stay constant. We also show how this simple model can be extended to more complex decision-making tasks such as when people have unequal priors or when they can choose to opt out of decisions. The theoretical model presented here provides an important framework to understand how, why, and whether decision boundaries should change over time in experiments on decision-making.     

Intersectional experiences of discrimination in a low‐resource urban community: An exploratory latent class analysis

There have been increasing calls for the application of an intersectionality framework to understand and address discrimination and health inequities among diverse communities. Yet there have been theoretical debates regarding to whom intersectionality applies and how intersectional experiences of discrimination are associated with health outcomes. The current study aimed to contribute to these theoretical debates and inform practical applications to reduce health inequities. Data were drawn from a community health survey in New Haven, CT (N = 1,293 adults) and analysed using latent class analysis. Results yielded 4 classes. Members of the 4 classes were similar sociodemographically. Three classes of participants reported experiencing discrimination, and members of these classes had greater stress, higher rates of smoking and sleep disruption, and worse overall health than members of the class reporting no discrimination. Members of 2 classes made multiple, or intersectional, attributions for discrimination, and members of these classes reported the most frequent discrimination. Findings suggest that community members who are sociodemographically similar may have diverse discrimination experiences. Multilevel interventions that address multiple forms of discrimination (e.g., racism and sexism) may hold promise for reducing discrimination and, ultimately, health inequities within low‐resource urban community settings.     

Fluctuating confidence: the dynamic consequences of true/false affirmatives and denials on how a listener appraises their personal past

The present study examined the mnemonic consequences of true/false denials and affirmatives on how a listener appraises their personal past. To this end, participants (listeners) rated the extent to which they were confident certain events occurred during their childhood. They rated these events both before and after a confederate (speaker) denied or affirmed the occurrence of four different childhood events each, for a total of eight “rehearsed” events. For each set (denials and affirmatives) of events, half were true and half were false. In turn, this created four types of events (two each): true denials, true affirmatives, false denials, and false affirmatives. Additionally, half of the participants were told that the speaker was provided independent information about the veracity of the event’s occurrence (“expert” condition). Overall, listeners were less confident in the occurrence of false denial events, but more so when they believed the speaker to be more knowledgeable of the listeners memories, more confident in false affirmative events and, counter intuitively, more confident in the occurrence of true denial events. These results underscore the importance of a nuanced approach to the mnemonic consequences of true and false denials and affirmations in the course of social interactions.