Randomized,placebo-controlled trial of cognitive-behavioral therapy alone or combined with sertraline in the treatment of pediatric obsessive–compulsive disorder

Background

To examine the efficacy of sequential sertraline and cognitive-behavioral therapy (CBT) treatment relative to CBT with pill placebo over 18 weeks in children and adolescents with obsessive–compulsive disorder (OCD).

Methods

Forty-seven children and adolescents with OCD (Range = 7–17 years) were randomized to 18-weeks of treatment in one of three arms: 1) sertraline at standard dosing + CBT (RegSert + CBT); 2) sertraline titrated slowly but achieving at least 8 weeks on the maximally tolerated daily dose + CBT (SloSert + CBT); or 3) pill placebo + CBT (PBO + CBT). Assessments were conducted at screening, baseline, weeks 1–9, 13, and 17, and post-treatment. Raters and clinicians were blinded to sertraline (but not CBT) randomization status. Primary outcomes included the Children's Yale-Brown Obsessive–Compulsive Scale, and response and remission status. Secondary outcomes included the Child Obsessive Compulsive Impact Scale–Parent/Child, Children's Depression Rating Scale-Revised, Multidimensional Anxiety Scale for Children, and Clinical-Global Impressions-Severity.

Results

All groups exhibited large within-group effects across outcomes. There was no group by time interaction across all outcomes suggesting that group changes over time were comparable.

Conclusions

Among youth with OCD, there was no evidence that sequentially provided sertraline with CBT differed from those receiving placebo with CBT.

ClinicalTrials.gov Identifier

NCT00382291.     

Complex Reaction Time and General Intelligence: A Refinement

College students (N = 28) completed a reaction-time task that yielded decision times for simple and complex conditions. Each student was also administered the revised edition of the Wechsler Adult Intelligence Scales (WAIS-R). Decision-time parameters generally correlated negatively with WAIS subscales. These correlations reached significance, however, mainly with timed performance subscales. The results were consistent with Vernon's (1983) results.     

Eating Behavior Among Thais and Americans

A cross-cultural analysis of eating patterns was conducted to examine the possible relationship between eating style and obesity. Thai and American students were surveyed about such bad eating habits as eating between meals, eating too quickly, eating when not hungry, and eating in response to external food cues. Contrary to the learning model of obesity, which postulates a causal relationship between eating style and body size, American subjects reported significantly better eating habits than did their much thinner Thai counterparts. A within-culture comparison of the American subjects showed a less significant but similar trend, with obese subjects claiming to have better eating patterns than both thin and underweight subjects.     

Cognitive Functioning in Aging and Dementia: The Kungsholmen Project

The Kungsholmen Project (KP) is a community-based longitudinal study of aging and dementia targeting the 75+ population. In this article, we review empirical studies with a cognitive focus from the KP. The main findings indicate that (a) there is an age-related decline for some cognitive domains (e.g., episodic memory, verbal fluency, visuoconstructive skill, psychomotor speed), but not for others (e.g., primary memory, visuoperceptive skill, motor-hand coordination), (b) multiple individual-difference variables within demographic (e.g., sex, education) life-style (e.g., activity levels), genetic (e.g., apolipoprotein E genotype), and health-related (e.g., vitamin B deficiency, depression, diabetes) domains are related to late-life cognitive functioning, (c) a potential for improving cognitive performance – a reserve capacity – is present also among very old adults, (d) the 2 most common dementia diseases, Alzheimer’s disease (AD) and vascular dementia (VaD), affect cognition in a strikingly similar manner, (e) the role of individual-difference variables in cognitive functioning is markedly reduced in dementia – the pathogenesis itself may overshadow the influence of other variables, and (f) there is a long preclinical period in dementia during which cognitive deficits are detectable. As is true with the other projects represented in this issue, the KP portrays a rather diversified picture of cognitive aging, although systematic patterns are evident with regard to the variability of late-life cognitive functioning.     

Semantic clustering as a neuropsychological predictor for amnestic-MCI

ABSTRACT

Recent research has demonstrated that patients with Alzheimer's disease (AD) show deficits in semantic processing when compared to cognitively healthy individuals. This difference is thought to be attributed to losses in higher cortical systems that are predominantly associated with executive functioning. The first aim of the study will be to determine if differences in semantic clustering can accurately differentiate patients with amnestic mild cognitive impairment (aMCI) from cognitively normal (CN) individuals. The second aim will be to determine the extent to which semantic processing might be associated with executive functions. Data from 202 (134 CN, 68 aMCI) participants were analyzed to quantify differences in semantic clustering ratios on the HVLT-R. Study participants ages ranged from 51 to 87 with education ranging from 6 to 20 years. ANCOVA revealed statistically significant differences on semantic clustering ratios (p < .001). Moderate correlations between semantic clustering Category Fluency Test (r = .45) were also found. Statistically significant group differences were also present on Trails-B and WAIS-R Digit Symbol performance (p < .001). Overall, these data indicate that deficits in semantic clustering are present in aMCI patients.     

Religious Commitment,Skepticism, and Struggle Among U.S. College Students: The Impact of Majority/Minority Religious Affiliation and Institutional Type

Using a longitudinal sample of over 14,000 undergraduate students, this study explores whether and how students’ religious transformations during the college years are associated with their religious affiliation, religious experiences, and the institutional characteristics of their college or university. Hierarchical linear modeling reveals that students from religious majority groups (i.e., mainline and evangelical Protestants) generally experience increased religious commitment and decreased religious skepticism as compared with students from religious minority groups. Interestingly, though, students from these majority groups also report greater levels of religious struggle compared to minority group students. Moreover, institutional religious affiliation and an inclusive campus religious climate often attenuate the relationship between students’ religious affiliation and their religious transformation. Environments at both the macro (campus) and micro (friendship groups) levels contribute critically to young adults’ religious commitment.     

The shared leadership process in decision-making teams

The present study examined the process of shared leadership in 45 ad hoc decision-making teams. Each team member's leadership behavior (n = 180) was assessed by behaviorally coding videotapes of the teams' discussions. The within-team patterns of leadership behavior were examined using cluster analysis. Results indicated that the likelihood of a team experiencing a full range of leadership behavior increased to the extent that multiple team members shared leadership, and that teams with shared leadership experienced less conflict, greater consensus, and higher intragroup trust and cohesion than teams without shared leadership. This study supports previous findings that shared leadership contributes to overall team functioning, and begins to delineate the extent to which team members may naturally share leadership.     

Gesture in the developing brain

Speakers convey meaning not only through words, but also through gestures. Although children are exposed to co-speech gestures from birth, we do not know how the developing brain comes to connect meaning conveyed in gesture with speech. We used functional magnetic resonance imaging (fMRI) to address this question and scanned 8- to 11-year-old children and adults listening to stories accompanied by hand movements, either meaningful co-speech gestures or meaningless self-adaptors. When listening to stories accompanied by both types of hand movement, both children and adults recruited inferior frontal, inferior parietal, and posterior temporal brain regions known to be involved in processing language not accompanied by hand movements. There were, however, age-related differences in activity in posterior superior temporal sulcus (STSp), inferior frontal gyrus, pars triangularis (IFGTr), and posterior middle temporal gyrus (MTGp) regions previously implicated in processing gesture. Both children and adults showed sensitivity to the meaning of hand movements in IFGTr and MTGp, but in different ways. Finally, we found that hand movement meaning modulates interactions between STSp and other posterior temporal and inferior parietal regions for adults, but not for children. These results shed light on the developing neural substrate for understanding meaning contributed by co-speech gesture.     

The Impact of Contextual Self‐Ratings and Observer Ratings of Personality on the Personality–Performance Relationship1

This study examined 2 possible ways of increasing the predictive validity of personality measures: using observer (i.e., supervisor and coworker) ratings and work‐specific self‐ratings of Big Five personality factors. Results indicated that among general self‐ratings of Big Five personality dimensions, Conscientiousness was the best predictor of in‐role performance, and Agreeableness and Emotional Stability were the best predictors of organizational citizenship behavior (OCB). Observer ratings of personality accounted for incremental variance in job performance (in‐role performance and OCB) beyond that accounted for by general self‐ratings. However, contrary to our expectations, work‐specific (i.e., contextual) self‐ratings of personality generally did not account for incremental variance in job performance beyond that accounted for by general self‐ratings.     

Training and careers in law and psychology: The perspective of students and graduates of dual degree programs

Over the last 15 years, commentators have discussed the relative merit—or lack of merit—of J.D.-Ph.D. training programs in law and psychology. Missing from the discussion, however, are the views of those who have enrolled in and completed dual degree programs. The authors, graduates of a law-psychology training program, provide both empirical data and their own views concerning the merit of joint degree training in law and psychology. As part of an effort to generate testable hypotheses regarding dual degree programs, the authors conclude that J.D.-Ph.D. training in law and psychology provides unique insights, skills and opportunities which may be unequalled by other approaches to training in the area.