Irritability in Children and Adolescents With OCD

Irritability is a common, impairing transdiagnostic symptom in childhood psychopathology, though it has not been comprehensively studied in pediatric obsessive-compulsive disorder (OCD). Further, the central cognitive behavioral treatment component for OCD, exposure and response prevention therapy (ERP), has been recently proposed as a treatment for irritability. This study aimed to evaluate whether certain clinical characteristics are associated with irritability in pediatric OCD and whether irritability reduces following ERP. Participants were 161 youth (ages 7–17) with OCD and a caregiver participating in a randomized controlled trial of D-cycloserine or pill placebo augmented ERP. Participants completed validated assessments during treatment. Irritability was significantly and positively associated with depressive symptoms, defiance, functional impairment, and family accommodation, but was not associated with pretreatment OCD severity, symptom dimensions, obsessive beliefs. Irritability significantly declined following treatment, with over half of youth with any pretreatment irritability experiencing clinically significant change, though this change was not related to OCD improvement. Results suggest that irritability may be a marker of psychiatric comorbidity, parental accommodation, and impairment in youth with OCD. Implications for the exposure-based treatment of irritability are discussed.     

The Relationship between Intimate Partner Violence and Suicidal Ideation among Young Chinese,Korean, and Vietnamese American Women

ABSTRACT

High depression and suicide rates are critical problems that have a significant impact on the lives of young Asian American women. Intimate partner violence (IPV) has been identified as a predictor of suicidality in general female samples, but no research study has examined the relationship between IPV and suicidality in a sample of 1.5 and second-generation Chinese, Korean, and Vietnamese American women. We used data collected from 173 women (aged 18-35 years) who were screened for eligibility to participate in the development and efficacy study of Asian American Women’s Action for Resilience and Empowerment (AWARE). We measured the prevalence of (a) IPV, (b) lifetime suicidal ideation/intent, and (c) childhood abuse and tested the association between IPV and lifetime suicidal ideation/intent among study participants who completed the clinical screening assessments. The results indicated that seven out of 10 women in our sample experienced lifetime suicidal ideation/intent, psychological aggression was the most commonly reported form of IPV during the last six months, followed by sexual coercion, and history of physical and/or sexual partner violence had the most robust association with lifetime suicidal ideation/intent after controlling for demographic factors and childhood abuse. Our study suggests that suicide prevention and intervention programs for young 1.5 and second-generation Asian American women should not only address experiences of childhood abuse, but also incorporate culturally adapted behavioral health approaches to identify and target physical and sexual partner violence. Furthermore, any such programs need to integrate a systemic approach in addressing IPV within the context of various marginalized experiences of Asian American women.     

Strangers in sync: Achieving embodied rapport through shared movements

This paper examines the emergence of behavioral synchrony among strangers in the context of self-disclosure, and their path in predicting interaction quality. Specifically, we hypothesize that behavioral synchrony mediates the direct effect of self-disclosure on the development of embodied rapport. Same-sex stranger pairs (n=94) were randomly assigned to a videorecorded self-disclosure or control condition, and afterward each member rated their social interaction. Following the procedure used by Bernieri, Reznick, & Rosenthal (1988), two trained judges independently watched each video record and rated each pair interaction on behavioral synchrony. Bootstrapping analyses provide support for the hypothesized mediating effect of behavioral synchrony, which emerged as independent of the effects of self-other overlap and positive affect. The authors discuss implications of behavioral synchrony for relationship formation processes and the inevitable entwinement of behavior and judgments in light of embodied cognition.     

Legal briefing: The unbefriended: making healthcare decisions for patients without surrogates (Part 2)

This issue's "Legal Briefing" column continues coverage of recent legal developments involving medical decision making for unbefriended patients. These patients have neither decision-making capacity nor a reasonably available surrogate to make healthcare decisions on their behalf. This topic has been the subject of recent articles in JCE. It has been the subject of major policy reports. Indeed, caring for the unbefriended has even been described as the "single greatest category of problems" encountered in bioethics consultation. Moreover, the scope of the problem continues to expand, especially with rapid growth in the elderly population and with an increased prevalence of dementia. Unfortunately, most U.S.jurisdictions have failed to adopt effective healthcare decision-making systems or procedures for the unbefriended. "Existing mechanisms to address the issue of decision making for the unbefriended are scant and not uniform." Most providers are "muddling through on an ad hoc basis." Still, over the past several months, a number of state legislatures have finally addressed the issue. These developments and a survey of the current landscape are grouped into the following 14 categories. The first two categories define the problem of medical decision making for the unbefriended.The remaining 12 describe different solutions to the problem. The first six categories were covered in Part 1 of this article; the last eight categories are covered in this issue (Part 2). 1. Who are the unbefriended? 2. Risks and problems of the unbefriended. 3. Prevention: advance care planning, diligent searching, and careful capacity assessment. 4. Decision-making mechanisms and standards. 5. Emergency exception to informed consent. 6. Expanded default surrogate lists: close friends. 7. Private guardians. 8. Volunteer guardians. 9. Public guardians. 10. Temporary and emergency guardians. 11. Attending physicians. 12. Other clinicians, individuals, and entities. 13. Institutional committees. 14. External committees.     

A Test and Extension of the Demand/Control/Social Support Model: Prediction of Wellness/Health Outcomes in Greek Teachers

The present study investigated the relationship between job characteristics, coping strategies and job satisfaction, burnout and somatic complaints in 215 Greek secondary school teachers in the urban area of Thessaloniki, as part of the EUROTEACH project (11 countries, 2164 teachers). The study aimed at testing the hypotheses of the Demand-Control-Social support model (Karasek, <citeref rid="bib20">1979</citeref>); and examining whether additional job characteristics (working hours, environmental risks, meaningfulness and physical exertion) as well as the inclusion of coping strategies could improve the model. Instruments included the Leiden Quality of Work Questionnaire for Teachers; the SCL-90 somatisation scale; the Maslach Burnout Inventory; and the CISS. Results indicated that all three components of the original model are associated with the outcomes with some associations being nonlinear. However, the moderating effects of control and social support are not supported by the data. Regarding coping, results indicated that coping variables can explain variance in most of the outcomes of the study, in addition to all job characteristics. Regarding the additional job characteristics, meaningfulness of work is the most important predictor. In order to understand these findings better, the Greek data were compared to that of the EUROTEACH group. This comparison revealed that the Greek teachers differ from their European counterparts in most study variables. The direction is mainly to the positive side, with the exception of the experience of less control on the job. The implications of these findings concerning model-based studies on teachers are discussed.     

Patterns of Posttraumatic Stress Symptoms Among United States Air Force Combat Search and Rescue Personnel

U.S. Air Force (USAF) combat search and rescue (CSAR) aircrew and special duty rescue personnel are specially trained airmen with high levels of direct exposure to combat-related medical trauma. The purpose of this study was to explore the prevalence rate of CSAR military personnel meeting the Diagnostic and Statistical Manual of Mental Disorders (fifth edition; DSM–5) posttraumatic stress disorder (PTSD) symptom criteria. USAF CSAR aircrew (n = 128) and rescue personnel (n = 300) across multiple units participated in the study by completing a demographics survey and the PTSD checklist based on DSM–5. Fourteen participants endorsed a pattern of symptoms of moderate to extreme level of severity meeting PTSD diagnostic criteria. Recommendations are provided for line and medical leadership to optimize health and performance among CSAR personnel.     

Verbal and Affective Laterality Effects in P-Dyslexic,L-Dyslexic and Normal Children

Lateralization of verbal and affective processes was investigated in P-dyslexic, L-dyslexic and normal children with the aid of a dichotic listening task. The children were asked to detect either the presence of a specific target word or of words spoken in a specific emotional tone of voice. The number of correct responses and reaction time were recorded. For monitoring words, an overall right ear advantage was obtained. However, further tests showed no significant ear advantage for P-types, and a right ear advantage for L-types and controls. For emotions, an overall left ear advantage was obtained that was less robust than the word-effect. The results of the word task are in support of previous findings concerning differences between P- and L-dyslexics in verbal processing according to the balance model of dyslexia. However, dyslexic children do not differ from controls on processing of emotional prosody although certain task variables may have affected this result.     

Development of the Significant Other Survey: An Interview for Family Members of Substance Users

The Significant Other Survey (SOS) is a semi-structured interview designed to measure the multidimensional problems experienced by family members with a substance abusing loved one. This article describes the development of the SOS and its psychometric properties based on data obtained from significant others of 110 substance abusing adults. Interrater and test-retest reliability estimates were within acceptable ranges, adequate internal consistency was demonstrated for six of seven problem domains, and the problem domains were low to moderately correlated with each other. Issues related to future instrument development and the utility of the SOS for both family practitioners and researchers are described.     

Implicit interpretation biases affect emotional vulnerability: A training study

Cognitive theories of emotion propose that the interpretation of emotion-eliciting situations crucially shapes affective responses. Implicit or automatic biases in these interpretations may hinder emotion regulation and thereby increase risk for the onset and maintenance of psychological disorders. In this study, participants were randomly assigned to a positive or negative interpretation bias training using ambiguous social scenarios. After the completion of the training, a stress task was administered and changes in positive and negative affect and self-esteem were assessed. The results demonstrate that the interpretation bias training was successful in that participants exhibited a tendency to interpret novel scenarios in accordance with their training condition. Importantly, the positive training condition also had a protective effect on self-esteem. Participants in this condition did not exhibit a decrease in self-esteem after the stress task, whereas participants in the negative condition did. These results demonstrate that implicit cognitive biases can be trained and that this training affects self-esteem. Implications of these findings for research on psychopathology and emotion regulation are discussed.