Deficits in Attention to Emotional Stimuli Distinguish Youth with Severe Mood Dysregulation from Youth with Bipolar Disorder

Studying attention in the context of emotional stimuli may aid in differentiating pediatric bipolar disorder (BD) from severe mood dysregulation (SMD). SMD is characterized by chronic irritability, arousal, and hyper-reactivity; SMD youth frequently receive a BD diagnosis although they do not meet DSM-IV criteria for BD because they lack manic episodes. We compared 57 BD (14.4 ± 2.9 years old, 56% male), 41 SMD (12.6 ± 2.6 years old, 66% male), and 33 control subjects (13.7 ± 2.5 years old, 52% male) using the Emotional Interrupt task, which examines how attention is impacted by positive, negative, or neutral distracters. We compared reaction time (RT) and accuracy and calculated attention interference scores by subtracting performance on neutral trials from emotional trials. Between-group analyses indicated that SMD subjects had significantly reduced attention interference from emotional distracters relative to BD and control subjects. Thus, attention in SMD youth was not modulated by emotional stimuli. This blunted response in SMD youth may contribute to their affective and behavioral dysregulation.     

Recognizing young children in need of mental health assessment: Development and preliminary validity of the early childhood screening assessment

The Early Childhood Screening Assessment (ECSA) is a primary care screening measure developed to identify very young children (1½–5 years old) who need further emotional or behavioral assessment. The ECSA was developed specifically to meet the logistical constraints of primary care settings. This study assessed the preliminary psychometric properties of the ECSA by comparing it with extant validated measures of young children's emotional and behavioral development, comparing it with a diagnostic interview, and measuring test‐retest reliability. In the study, 309 mothers in two primary care clinics completed the ECSA and the Child Behavior Checklist (CBCL; T. Achenbach & L. Rescorla, 2000). A subset (n = 69) also completed the Diagnostic Interview for the Preschool Age (DIPA; M. Scheeringa & N. Haslett, 2010). ECSA score correlated significantly and strongly with the CBCL Total Problem T score (Spearman's rho = 0.86, p ? .01). The ECSA was 86% sensitive and 83% specific in identifying DIPA diagnoses. Internal consistency of the ECSA was 0.91. Test‐retest reliability at 10 days was excellent (Spearman's rho = 0.81, p ? .01). The ECSA is an easy‐to‐use screening measure that demonstrates strong convergent validity, criterion validity, and test‐retest reliability in the pediatric setting. It shows potential as a feasible and psychometrically strong tool for busy primary care providers to identify preschoolers who need further socioemotional assessment.     

PSYCHOLOGICAL OUTCOMES AMONG LESBIAN SEXUAL ASSAULT SURVIVORS: AN EXAMINATION OF THE ROLES OF INTERNALIZED HOMOPHOBIA AND EXPERIENTIAL AVOIDANCE

This study explored the relations among internalized homophobia (IH), experiential avoidance, and psychological symptom severity in a community sample of 72 lesbian sexual assault survivors. Results indicated that IH is associated with both experiential avoidance and posttraumatic stress disorder (PTSD) symptom severity. In addition, experiential avoidance is related to both PTSD and depression symptom severity. Finally, experiential avoidance completely mediated the relation between IH and PTSD symptom severity. The implications of these findings are discussed and suggestions for future research are provided.     

Error processes in syllogistic reasoning

In recent years, a number of proposals have been advanced to account for the errors that subjects make in deductive inferences from invalid syllogisms. Principles such as erroneous conversion of premises, probabilistic inference, feature selection, and various other interpretation and combination processes have been suggested. The present paper focuses on the 32 invalid categorical syllogisms for which conversion of premises does not provide an explanation of subject error. An explanation is presented in terms of three error processes: the erroneous conversion of conclusions resulting from backward processing, the erroneous integration of information from the two premises, and the failure to consider hypothetical possibilities. Empirical predictions regarding the differential difficulty of the various premise combinations as well as the pattern of correlations between premise combinations are derived from this formulation, and data are presented that support these predictions.     

Risky assessments: participant suicidality and distress associated with research assessments in a treatment study of suicidal behavior

The purpose of this study was to examine patterns of self-reported suicidality and distress during research assessments in a sample of 63 women meeting criteria for borderline personality disorder and current and chronic suicidality. The risk management protocol we used during the two-year study period (University of Washington Risk Assessment Protocol; UWRAP) is described. Results indicated that changes in suicidality following assessments were small and relatively infrequent, and were just as likely to reflect decreases in suicidality as increases (17.5% versus 16.4% of sessions, respectively). Further, longitudinal analyses indicated that changes in suicidality became increasingly rare over the course of the 2-year study. Ratings of distress were more changeable than suicidality, underscoring the need for separate measurement of these constructs when assessing risk. With the aid of the UWRAP, our assessors judged 15 participants as high-risk status in 28 assessment sessions (3.7% of all sessions). In comparison to the rest of the sample, these individuals were of significantly greater clinical severity as measured by the HRSD 17-item, GAF scores, number and severity of previous suicide attempts, and number of previous psychiatric hospitalizations. Low-intensity risk intervention strategies (e.g., validating participant's feelings) were typically sufficient to reduce risk in these participants. Overall, our findings indicate that research with highly suicidal individuals can be done safely with the use of well-trained assessors and an appropriate crisis management protocol.     

Responses of ankle musculature of healthy subjects and hemiplegic patients to sinusoidal anterior-posterior movements of the base of support

The responses of the medical gastrocnemius and tibialis anterior muscles to continuous sinusoidal perturbation of the base of support were studied in two groups of subjects, forty-two volunteers aged 20 to 84 years and 17 hemiplegic patients aged 52 to 81 years. EMGs were recorded while subjects stood on a platform oscillating in the anterior-posterior direction. Movement amplitude was adjusted to the maximum the subject could sustain without assisted support within the limits of the instrument. In healthy subjects, two basic activation modes were indicated: (a) a reciprocal contraction pattern in which activity of the medial gastrocnemius and tibialis anterior muscles was concentrated in the anterior and posterior half of the oscillation, respectively. This pattern prevailed in the younger subjects whose maximal movement amplitude reached the highest limit of the instrument; (b) a less discrete pattern, characterized by tonic contraction and periods of coactivation of the two muscles, was seen in older subjects who had difficulties in maintaining stance on the moving platform. The disruption of the discrete reciprocal response mode in this group of patients was related to decline in function of postural mechanisms with aging and demanded additional stiffening of the ankle join, presumably a manifestation of reduced automatism in favor of closer CNS modulation. The typical response mode in the sound leg of the hemiplegic patients was variable coactivation of the two muscles. In the afflicted leg, the establishment of a motor set was impaired: Low tone was associated with negligible muscular activity, although with more elevated tone, low level uniform cocontraction was evident.     

Trajectories of Response to Treatment for Posttraumatic Stress Disorder

Research on the predictors of response to cognitive-behavioral treatments for PTSD has often produced inconsistent or ambiguous results. We argue this is in part due to the use of statistical techniques that explore relationships among the entire sample of participants rather than homogeneous subgroups. Using 2 large randomized controlled trials of Cognitive Processing Therapy (CPT), CPT components, and Prolonged Exposure, we employed growth mixture modeling to identify distinct trajectories of treatment response and to determine the predictors of those trajectories. We determined that the participants’ trajectories could be best represented by 2 latent classes, which we subsequently labeled responders (87% of the sample) and nonresponders (13% of the sample). Notably, there was not a separate class for partial responders. Assignment to the nonresponder class was associated with receiving the written accounts (WA) component of CPT, a pretreatment diagnosis of major depression (MDD), and more pretreatment hyperarousal symptoms. Thus, it appears that some individuals do not benefit from merely writing about their trauma and processing it with the therapist; they may also need to engage in cognitive restructuring to successfully ameliorate their symptoms. Additionally, those who meet criteria for MDD or have high levels of hyperarousal at the onset of treatment might require additional treatment or support.     

Metronome rate and walking foot contact time in young adults

It is assumed that when people walk guided by an audible constant rate, they match foot contact to the external pace. The purpose of this preliminary study was to test that assumption by examining the temporal relationship between audible signals generated by a metronome and foot contact time during gait. Ten healthy young women were tested in walking repetitions guided by metronome rates of 60, 110, and 150 beats/min. Metronome beats and foot contact times were collected in real time. The findings indicated that foot contact was not fully synchronized with the auditory signals; the shortest time interval between the metronome beat and foot contact time was at the prescribed rate of 60 beats/min., while the longest interval was at the rate of 150 beats/min. The correlation between left and right foot contact times was highest with the slowest rate and lowest with the fastest rate.     

Adolescent suicide and defensive style.

This empirical study investigated the relation between ego defense mechanisms, diagnoses, and suicidality among 200 adolescent psychiatric patients ages 12 to 16 years. Based on a structured diagnostic interview, adolescents were divided into three groups: suicide attempters, suicidal ideators, and nonsuicidal patients. Using the Defense Mechanisms Inventory (DMI), suicidal adolescents scored higher on the defense of turning-against-self and lower on reversal, as compared to nonsuicidal adolescents. Although suicide was significantly more common among adolescents with an affective disorder, turning-against-self remained significantly associated with suicide attempt even when diagnosis was controlled for. Results demonstrate the importance of defense mechanisms in understanding adolescent suicidal behavior.