The Premonitory Urge to Tic: Measurement,Characteristics, and Correlates in Older Adolescents and Adults

In addition to motor and/or vocal tics, many individuals with Tourette syndrome (TS) or chronic tic disorder (CTD) report frequent, uncomfortable sensory phenomena that immediately precede the tics. To date, examination of these premonitory sensations or urges has been limited by inconsistent assessment tools. In this paper, we examine the psychometric properties of a nine-item self-report measure, the Premonitory Urge to Tic Scale (PUTS) and examine the characteristics and correlates of the premonitory urge to tic in a clinical sample of 122 older adolescents and adults with TS or CTD. The PUTS demonstrated adequate internal consistency, temporal stability, and concurrent validity. Premonitory urges were endorsed by the majority of individuals. Most individuals reported some relief from the urges after completing a tic and being able to stop their tics even if only temporarily. Degree of premonitory urges was not significantly correlated with age, and we did not observe any gender differences. Degree of premonitory urges was significantly correlated with estimated IQ and tic severity, but not severity of comorbid obsessive–compulsive disorder or attention-deficit hyperactivity disorder. Also, it was not related to concomitant medication status. These findings represent another step forward in our understanding of the premonitory sensations associated with TS and CTD.     

Imminent Danger? Probabilistic Classification Learning of Threat-Related Information in Obsessive-Compulsive Disorder

A tendency to overestimate threat has been shown in individuals with OCD. We tested the hypothesis that this bias in judgment is related to difficulties in learning probabilistic associations between events. Thirty participants with OCD and 30 matched healthy controls completed a learning experiment involving 2 variants of a probabilistic classification learning task. In the neutral weather-prediction task, rainy and sunny weather had to be predicted. In the emotional task danger of an epidemic from virus infection had to be predicted (epidemic-prediction task). Participants with OCD were as able as controls to improve their prediction of neutral events across learning trials but scored significantly below healthy controls on the epidemic-prediction task. Lower performance on the emotional task variant was significantly related to a heightened tendency to overestimate threat. Biased information processing in OCD might thus hamper corrective experiences regarding the probability of threatening events.     

Heterogeneity of treatment changes after psychodynamic therapy within a one year follow‐up: A replication study

Naturalistic psychotherapy effect studies commonly report effect sizes for the total sample. However, a previous study of SCL‐90 Global Severity Index (GSI) improvement in a large outpatient sample used a cluster analytic strategy and reported clinical relevant outcome trajectories that could be grouped into early within‐treatment improvement, late improvement in the follow‐up period, and deteriorating patients with slight improvement that was lost at follow‐up. We explore GSI outcome trajectories and clinical significant change in a sample of 320 patients at a public psychiatric outpatient psychodynamic group therapy unit, the majority with anxiety, personality, and mood disorders. The study revealed large discharge and follow‐up effect sizes but more than one third of the patients were without measurable improvement. The major clusters described above were confirmed, and revealed unique clinical and socio‐demographic characteristics. Late improvers, as compared with early improvers, were characterized by anxiety symptoms and lack of network support after controlling for GSI at admission. Similarly, deteriorating patients had longer duration of illness and less favourable social characteristics compared with the other two groups. Early improving patients were less likely to have participated in short‐term groups, and only one third participated in additional treatment compared with more than 69% of the other patients. Severe and socially affected psychiatric patients, and patients with anxiety and agoraphobic symptoms may be less optimally treated in short‐term time limited psychodynamic groups. There is an obvious need for diversity of treatment offers, better integration of psycho‐social treatment components, and long‐term open ended treatment.     

An atypical anxious‐impulsive pattern of social anxiety disorder in an adult clinical population

An atypical subgroup of Social Anxiety Disorder (SAD) with impulsive rather than inhibited traits has recently been reported. The current study examined whether such an atypical subgroup could be identified in a clinical population of 84 adults with SAD. The temperament dimensions harm avoidance and novelty seeking of the Temperament and Character Inventory, and the Liebowitz Social Anxiety Scale were used in cluster analyses. The identified clusters were compared on depressive symptoms, the character dimension self‐directedness, and treatment outcome. Among the six identified clusters, 24% of the sample had atypical characteristics, demonstrating mainly generalized SAD in combination with coexisting traits of inhibition and impulsivity. As additional signs of severity, this group showed low self‐directedness and high levels of depressive symptoms. We also identified a typically inhibited subgroup comprising generalized SAD with high levels of harm avoidance and low levels of novelty seeking, with a similar clinical severity as the atypical subgroup. Thus, higher levels of harm avoidance and social anxiety in combination with higher or lower levels of novelty seeking and low self‐directedness seem to contribute to a more severe clinical picture. Post hoc examination of the treatment outcome in these subgroups showed that only 20 to 30% achieved clinically significant change.     

Randomized controlled trial of parental responsiveness intervention for toddlers at high risk for autism

This study tested the effects of a parent-mediated intervention on parental responsiveness with their toddlers at high risk for an autism spectrum disorder (ASD).Participants included caregivers and their 66 toddlers at high risk for ASD. Caregivers were randomized to 12 sessions of an individualized parent education intervention aimed at improving parental responsiveness or to a monitoring control group involving 4 sessions of behavioral support. Parental responsiveness and child outcomes were measured at three time points: at beginning and end of the 3-month treatment and at 12-months post-study entry. Parental responsiveness improved significantly in the treatment group but not the control group. However, parental responsiveness was not fully maintained at follow up. There were no treatment effects on child outcomes of joint attention or language. Children in both groups made significant developmental gains in cognition and language skills over one year. These results support parental responsiveness as an important intervention target given its general association with child outcomes in the extant literature; however, additional supports are likely needed to fully maintain the treatment effect and to affect child outcomes.     

Positive beliefs about worry: A psychometric evaluation of the Why Worry-II

Positive beliefs about worry are theorized to maintain excessive and uncontrollable worry, the hallmark of generalized anxiety disorder (GAD; American Psychiatric Association, 2013). The Why Worry-II (WW-II) is a 25-item revised questionnaire designed to measure five positive beliefs about worry. These five beliefs are that worry: (1) facilitates problem solving; (2) enhances motivation; (3) protects against negative emotions; (4) prevents negative outcomes; and (5) reflects a positive personality trait. The main goal of this study was to assess the WW-II’s psychometric properties, including its factor structure. Undergraduate participants (N = 309) completed the WW-II, and measures of worry, depression, anxiety, and positive and negative beliefs about worry. Overall, the results suggest that the five-factor model is a good fit to the data. The WW-II demonstrated excellent internal consistency, good test–retest reliability at six weeks, and evidence of convergent and divergent validity. The WW-II also uniquely predicted worry severity. Overall, our findings suggest that the WW-II has a five-factor structure congruent with theoretical predictions, sound psychometric properties, and a unique relationship to excessive worry. The theoretical and clinical implications of these findings are discussed.     

Acceptability of virtual reality interoceptive exposure for the treatment of panic disorder with agoraphobia

Interoceptive exposure (IE) is a standard component of cognitive-behavioural therapy (CBT) for panic disorder and agoraphobia. The virtual reality (VR) program ‘Panic-Agoraphobia’ has several virtual scenarios designed for applying exposure to agoraphobic situations; it can also simulate physical sensations. This work examines patients' acceptability of the IE component as applied in two different ways: using VR versus traditional IE. Additionally, it explores the relationship between users' treatment expectations and satisfaction and clinically significant change. Results showed that VR and traditional IE were well accepted by all participants. Furthermore, treatment expectations predicted efficacy.     

Neural processing of intentional biological motion in unaffected siblings of children with autism spectrum disorder: An fMRI study

Despite often showing behaviorally typical levels of social cognitive ability, unaffected siblings of children with autism spectrum disorder have been found to show similar functional and morphological deficits within brain regions associated with social processing. They have also been reported to show increased activation to biological motion in these same regions, such as the posterior superior temporal sulcus (pSTS), relative to both children with autism and control children. It has been suggested that this increased activation may represent a compensatory reorganization of these regions as a result of the highly heritable genetic influence of autism. However, the response patterns of unaffected siblings in the domain of action perception are unstudied, and the phenomenon of compensatory activation has not yet been replicated. The present study used functional magnetic resonance imaging to determine the neural responses to intentional biological actions in 22 siblings of children with autism and 22 matched controls. The presented actions were either congruent or incongruent with the actor’s emotional cue. Prior studies reported that typically developing children and adults, but not children with autism, show increased activation to incongruent actions (relative to congruent), within the pSTS and dorsolateral prefrontal cortex. We report that unaffected siblings did not show a compensatory response, or a preference for incongruent over congruent trials, in any brain region. Moreover, interaction analyses revealed a sub-region of the pSTS in which control children showed an incongruency preference to a significantly greater degree than siblings, which suggests a localized deficit in siblings. A sample of children with autism also did not show differential activation in the pSTS, providing further evidence that it is an area of selective disruption in children with autism and siblings. While reduced activation to both conditions was unique to the autism sample, lack of differentiation to incongruent and congruent intentional actions was common to both children with ASD and unaffected siblings.     

BDNF serum levels in subjects developing or not post-traumatic stress disorder after trauma exposure

Post-traumatic stress disorder (PTSD) is a syndrome resulting from exposure to a severe traumatic event that poses threatened death or injury and produces intense fear and helplessness. The neural structures implicated in PTSD development belong to the limbic system, an important region for emotional processing. Brain-derived neurotrophic factor (BDNF) is a neurotrophin that serves as survival factor for selected populations of central nervous system (CNS) neurons and plays a role in the limbic system by regulating synaptic plasticity, memory processes and behavior. Impaired BDNF production in the brain can lead to a variety of CNS dysfunctions including symptoms associated with PTSD. However, so far fewer studies have investigated this neurotrophin in patients with PTSD. Furthermore, given the multiple role of BDNF in various CNS disorders, it cannot be excluded that traumatic events per se may influence neurotrophin levels, without a direct association to the PTSD syndrome.