Integrating Pain Management in Clinical Practice

There is much evidence to suggest that psychological and social issues are predictive of pain severity, emotional distress, work disability, and response to medical treatments among persons with chronic pain. Psychologists can play an important role in the identification of psychological and social dysfunction and in matching personal characteristics to effective interventions as part of a multidisciplinary approach to pain management, leading to a greater likelihood of treatment success. The assessment of different domains using semi-structured clinical interviews and standardized self-report measures permits identification of somatosensory, emotional, cognitive, behavioral and social issues in order to facilitate treatment planning. In this paper, we briefly describe measures to assess constructs related to pain and intervention strategies for the behavioral treatment of chronic pain and discuss related psychiatric and substance abuse issues. Finally, we offer a future look at the role of integrating pain management in clinical practice in the psychological assessment and treatment for persons with chronic pain.     

An interpersonal analysis of pathological personality traits in DSM-5

The proposed changes to the personality disorder section of the Diagnostic and statistical manual of mental disorders (5th ed.) places an increased focus on interpersonal impairment as one of the defining features of personality psychopathology. In addition, a proposed trait model has been offered to provide a means of capturing phenotypic variation on the expression of personality disorder. In this study, the authors subject the proposed DSM-5 traits to interpersonal analysis using the inventory of interpersonal problems-circumplex scales via the structural summary method for circumplex data. DSM-5 traits were consistently associated with generalized interpersonal dysfunction suggesting that they are maladaptive in nature, the majority of traits demonstrated discriminant validity with prototypical and differentiated interpersonal problem profiles, and conformed well to a priori hypothesized associations. These results are discussed in the context of the DSM-5 proposal and contemporary interpersonal theory, with a particular focus on potential areas for expansion of the DSM-5 trait model.     

MMPI-2-RF characteristics of custody evaluation litigants

The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) is a 338-item objective self-report measure drawn from the 567 items of the MMPI-2. Although there is a substantial MMPI-2 literature regarding child custody litigants, there has been only one previously published study using MMPI-2-RF data in this population that focused on Validity scales L-r and K-r. The current study evaluated the MMPI-2-RF results of 344 child custody litigants and showed substantial consistency between T-score elevations typically found on MMPI-2 Validity scales L and K, and comparable elevations for MMPI-2-RF validity scales L-r and K-r. Mean T-scores well within normal limits characterized results for clinical scales on both instruments. The RC scale intercorrelation patterns, and alpha coefficient values found for MMPI-2-RF scales in a custody population, were also found to be very similar to those reported for other populations. Directions for future research are presented.     

Taxometric analysis as a general strategy for distinguishing categorical from dimensional latent structure

Statistical analyses investigating latent structure can be divided into those that estimate structural model parameters and those that detect the structural model type. The most basic distinction among structure types is between categorical (discrete) and dimensional (continuous) models. It is a common, and potentially misleading, practice to apply some method for estimating a latent structural model such as factor analysis without first verifying that the latent structure type assumed by that method applies to the data. The taxometric method was developed specifically to distinguish between dimensional and 2-class models. This study evaluated the taxometric method as a means of identifying categorical structures in general. We assessed the ability of the taxometric method to distinguish between dimensional (1-class) and categorical (2-5 classes) latent structures and to estimate the number of classes in categorical datasets. Based on 50,000 Monte Carlo datasets (10,000 per structure type), and using the comparison curve fit index averaged across 3 taxometric procedures (Mean Above Minus Below A Cut, Maximum Covariance, and Latent Mode Factor Analysis) as the criterion for latent structure, the taxometric method was found superior to finite mixture modeling for distinguishing between dimensional and categorical models. A multistep iterative process of applying taxometric procedures to the data often failed to identify the number of classes in the categorical datasets accurately, however. It is concluded that the taxometric method may be an effective approach to distinguishing between dimensional and categorical structure but that other latent modeling procedures may be more effective for specifying the model.     

Time Course of Treatment Effect of OROS(R) Methylphenidate in Children With ADHD

Objective: The authors evaluated the time course of the treatment effect of Osmotic-Release Oral System methylphenidate (OROS(?) MPH) HCl (Concerta(?), Raritan, NJ) CII in children with ADHD. Method: Data were combined from two double-blind, randomized, placebo-controlled, cross-over, analog classroom studies in children (9-12 years) with ADHD. Participants received an individualized dose of placebo or OROS(?) MPH on two laboratory school days. Permanent Product Math Test and Swanson, Kotkin, Agler, M-Flynn, and Pelham scores were evaluated 0.5 hr before dosing and 1, 2, 4, 10, 11, and 12.5 hr post dose. Analysis used a repeated-measures mixed model. Results: Treatment effects were present at all postdose assessment points (p < .0001 for all comparisons, n = 139). Adverse events were similar to previous reports for OROS(?) MPH. Conclusion: A robust treatment effect occurred with OROS(?) MPH; onset was at 1 hr and persisted for at least 12.5 hr after dosing.     

A Randomized, Double-Blind, Crossover Comparison of MK-0929 and Placebo in the Treatment of Adults With ADHD

Objective: Preclinical models, receptor localization, and genetic linkage data support the role of D4 receptors in the etiology of ADHD. This proof-of-concept study was designed to evaluate MK-0929, a selective D4 receptor antagonist as treatment for adult ADHD. Method: A randomized, double-blind, placebo-controlled, crossover study was conducted in adults with primary ADHD. The primary end point was changed from baseline in total score on the Adult ADHD Investigator Symptom Rating Scale following a 4-week treatment regimen. Additional measures included Clinical Global Impression-Severity Scale, Hospital Anxiety and Depression Scale, and Brown Attention Deficit Disorder Scale and D4 genotype analysis. Results: No statistically significant treatment differences were found between MK-0929 and placebo in any of the primary or secondary assessments. Conclusion: Results from this study suggest that blockade of the D4 receptor alone is not efficacious in the treatment of adult ADHD.     

The etiology of variation in language skills changes with development: a longitudinal twin study of language from 2 to 12 years

The present study is the first long-term longitudinal examination of the etiology of individual differences in language from early childhood through to adolescence. We applied a multivariate latent factor genetic model to longitudinal data from the Twins Early Development Study in order to (a) compare the magnitude of genetic and environmental influences on language skills in early childhood (2, 3 and 4 years), middle childhood (7, 9 and 10 years), and early adolescence (12 years); and (b) determine to what extent the same genetic and environmental factors underlie variation in language skills at these three stages of language development. We found that while shared environmental influences appear to be dominant (latent factor c2 = .74) in early language, with a smaller though significant role for genetic factors (latent factor a2 = .24), the pattern is reversed by middle childhood such that genetic influences are substantially more important (latent factor a2 = .57-.63 at 7, 9 and 10 years and .47-.57 at 12 years) and shared environmental influences less so (latent factor c2 = .31-.37 at 7, 9 and 10 years and .31-.32 at 12 years). The increase in the heritability of language skills between early and middle childhood appears to be due to new genetic factors that come into play at that transition. In contrast, genetic factors remain stable from middle childhood through to early adolescence, and account for the phenotypic continuity in language skills across these two stages.     

The influence of control and related variables on commuting stress

Existing research on commuting stress has shown that it is affected by variables such as control, predictability, the duration of the commute and impedance. The present study investigates the impact of several factors on the stress that commuters experience and clarifies possible relations between variables. For the purpose of this study, an online questionnaire was completed by 363 commuters of the Vienna region. The relative strength of the relationship between predictors and commuting stress was determined by multiple regression analysis. Results suggest that control is the most powerful predictor of commuting stress, followed by the duration of the commute, predictability and impedance. Control significantly interacts with the duration of the commute and predictability. Based on these findings a research model is proposed, clearly depicting the moderating impact of the duration of the commute and incorporating a clear distinction between predictability and control.