Antidepressant Medication: Is It a Viable and Valuable Adjunct to Cognitive-Behavioral Therapy for School Refusal?

Cognitive-behavioral therapy (CBT) is an evidence-based treatment for school refusal. However, some youth do not respond to CBT. The serious risks associated with school nonattendance call for novel approaches to help those who do not respond to CBT. Because school refusal is commonly associated with anxiety disorders, and the combination of CBT and antidepressant medication enhances outcomes in the treatment of anxiety disorders, combined treatment may be effective for school refusal. This narrative review evaluates the current evidence base for adding antidepressant treatment to CBT for school refusal. Six randomized controlled trials (RCTs), two open trials, six case studies/series, and one observational study were identified and reviewed. There is support for combined CBT and imipramine, but this medication is not typically used due to the risk of concerning side effects. Two recent RCTs failed to provide evidence for the superiority of combined CBT and fluoxetine. Further research in this area is required because the extant studies have a number of methodological limitations. Recommendations are provided for clinicians who consider prescribing antidepressant medication or referring for adjunctive antidepressant treatment for school refusal.     

Different Disgust Domains Specifically Relate to Mental and Contact Contamination Fear in Obsessive-Compulsive Disorder: Evidence From a Path Analytic Model in an Italian Clinical Sample

Both contact contamination (CC) and mental contamination (MC) fears—which combined represent the most common manifestation of obsessive-compulsive disorder (OCD)—have been widely associated with disgust propensity. However, extant research explored this relationship using measures assessing only pathogen-related disgust, not taking into account the potential role played by sexual and moral disgust, despite literature about MC suggesting that this might be particularly relevant. In Study 1, the psychometric properties of the Italian version of the Three Domains of Disgust Scale (TDDS) were assessed in a large Italian community sample. Exploratory and confirmatory factor analyses confirmed the three-factor structure of the TDDS. The scale also showed good internal consistency and construct validity. In Study 2, the differential patterns of relationships between CC and MC and the three disgust domains were explored in an Italian clinical OCD sample using a path analytic approach. The TDDS-Pathogen subscale was a unique predictor of CC while the TDDS-Sexual subscale was a unique predictor of MC, after controlling for anxiety and depression. Surprisingly, the TDDS-Moral subscale was not a predictor of either domain of contamination fear. Limitations and clinical implications are discussed.     

The relationship between religion and health-related behaviours in patients with borderline personality disorder

With addictive disorders frequently co-occurring among patients with borderline personality disorder (BPD), exploring factors that may influence health-related behaviours, like religious involvement, is important. This study assesses whether religious involvement is associated with smoking and alcohol use disorders (AUDs) in BPD subjects. This study used data from Wave 2 of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), which used the Alcohol Use Disorder and Associated Disabilities Interview Schedule–DSM-IV (AUDADIS-IV) as its assessment instrument. The AUDADIS-IV assessed personality disorders, tobacco usage, the presence of AUDs, and religious involvement. Attending a place of worship and weekly or more frequent worship attendance were significantly associated with reduced likelihood of current smoking and AUDs among BPD subjects. AUDs were also significantly less common in those reporting higher subjective religiousness. In conclusion, people with BPD who are religiously inclined are less likely to engage in addictive behaviours, specifically smoking and AUDs.     

The Yale-Brown Obsessive-Compulsive Scale: Confirmatory Factor Analytic Findings

The psychometric properties of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) have recently been heavily examined. Specifically, a number of researchers have been interested in determining the factor structure of this scale to find whether it best forms a one, two, or three factor model. The present study continued this examination by considering different scaling models using confirmatory factor analysis with a sample of individuals diagnosed with Obsessive-Compulsive Disorder (OCD). One hundred and forty-six individuals diagnosed with OCD participated and were administered the Y-BOCS and scales measuring depression (Hamilton Depression Rating Scale) and anxiety (Hamilton Anxiety Rating Scale). It was found that the Y-BOCS forms two different two-factor models. One model consisted of an obsessions and compulsions factor; the other composed of disturbance and symptom severity factors. It was likewise found that depression and anxiety were related to both factors in one model (disturbance and symptom severity). The finding that depression was related to obsessions and anxiety to compulsions was found, as in a previous factor analysis of the Y-BOCS. These findings suggest that OCD may be best characterized as a multidimensional syndrome that may not be adequately examined by a single unitary factor as described in the Y-BOCS.     

Cognitive Impairment and Its Relationship to Psychopathic Tendencies in Children with Emotional and Behavioral Difficulties

This study investigated whether performance on the card playing task (Newman, Patterson, & Kosson, 1987) and the moral/conventional distinction measure predict level of childhood conduct problems as indexed by the Psychopathy Screening Device (Frick & Hare, in press). The card-playing task indexes the child's sensitivity to changes in reinforcement rate. The moral/conventional distinction measure indexes the child's sensitivity to the difference between moral transgressions which result in harm to another from conventional transgressions which more usually result in social disorder. The Psychopathy Screening Device indexes a behavioral syndrome that consists of two dimensions: affective disturbance and impulsive and conduct problems. Thirty-nine children with emotional and behavioral difficulties were presented with both measures. Performance on both measures did predict extent of behavioral disturbance. Moreover, there was a significant association between performance on the card playing tasks and the moral/conventional distinction. The results are interpreted within the response set modulation and violence inhibition mechanism models and by reference to recent work at the anatomical level.     

Thoughts and feelings and things: A new psychiatric epistemology

Epistemology — the study of knowledge — is a philosophical discipline with close ties to psychiatry. When epistemologists address specific questions about how knowledge is actually realized by human beings, their philosophy must be informed by empirical studies of the sort psychiatrists now take up in a variety of forms. As this paper describes, psychiatrists can likewise improve their understanding of human psychology through a deeper appreciation of philosophical analysis in epistemology.The aim of this article is to introduce a unifying framework within which the experience from different approaches to psychiatry — (1) the conceptual schemas of cognitive psychiatry, (2) the mental structures of psychoanalytic psychiatry, (3) the categorical forms of existential psychiatry, and (4) the neural pathways of biological psychiatry — can all be applied productively to the central question of epistemology. By establishing a broad understanding of the problem of knowledge, this new view of epistemology is developed within the idiom of each psychiatric approach. In addressing themselves to a unitary problem, these diverse psychiatric approaches are themselves revealed, not as competing points of view, but as complementary views of a single subject. The result is a new epistemology that can not only bring the insights of psychiatry to philosophy, but can also contribute to the care of patients when psychiatrists bring this broader view to their clinical work.     

Mothers’ attuned responses to infant affect expressivity promote earlier achievement of language milestones

To investigate infants’ affective expressivity and maternal attuned responsiveness to infant expressivity in relation to early language achievement, 77 dyads were visited in their homes at 9 and 13 months, and mothers were interviewed about their children’s language between 9 and 21 months. Maternal responses that were attuned to infant affect, by selectively matching either the gradient features or the valence of infants’ affective expressions, were more predictive of children’s language achievement than maternal nonmatching responses; and maternal matching responses at 9 months were more predictive of children’s language achievements than maternal responses at 13 months. Moreover, maternal matching responses at 9 months predicted second-year language achievements over and above infant affect expressivity at 9 and 13 months, and over and above maternal matching responses at 13 months. Infants’ affective expressivity per se was not predictive.     

Callous-Unemotional Traits and Subtypes of Conduct Disorder

There has been growing consensus that children with conduct disorder (CD) constitute a very heterogeneous group containing children who vary substantially on the development, course, and causes of the disorder. While many have recognized the importance of this heterogeneity for developing better causal theories and for developing more effective treatments, there has been little consensus as to the best way to subtype children with CD. In this paper, we review a number of approaches to subtyping, each with some evidence for its validity for certain purposes. We focus on two recent approaches that have great potential for integrating past subtyping approaches and for advancing causal theory. The first approach is the division of children with CD into those with a childhood onset to their severe antisocial behavior and those with an adolescent onset to their behavior. The second approach is to designate children within the childhood-onset group who show callous and unemotional traits, which is analogous to adult conceptualizations of psychopathy. Both approaches help designate children who many show different causal processes underlying their severe aggressive and antisocial behavior, and who may warrant different approaches to treatment.     

Prevalence of personality disorders among bulimics,nonbulimic binge eaters,and normal controls

We examined the comorbidity of bulimia and personality pathology among college women. Subjects included women (n=23) meeting DSM-III-R criteria for bulimia nervosa (bulimics), women (n=23) who reported binge eating but did not fulfill the criteria for bulimia nervosa (binge eaters), and women (n=23) who did not binge eat (normals). The subjects completed an assessment battery consisting of the Personality Disorders Examination and the SCID as well as the Beck Depression Inventory, the Rosenberg Self-Esteem Index, and measures of impulsivity and self-defeating tendencies. Fourteen of 23 bulimics (61%) met criterion for a personality disorder using DSM-III-R Axis II criteria. In comparison, 3 of 23 (13%) binge eaters and 1 of 23 (4%) normal subjects received an Axis II diagnosis. Borderline and self-defeating diagnoses were the predominant personality disorders in 96% of the bulimics exhibiting clinically significant personality pathology. Bulimics also exhibited significantly more depression, impulsivity, and self-defeating behavior and lower self-esteem than binge eaters and normals. The findings are discussed within a conceptual framework that posits an interaction between personality pathology and restrained eating.     

Characterization of controlled gamblers and pathological gamblers using the social representation theory

Introduction

In industrialized countries, gambling disorder tends to become a major issue. The use of the social representation theory provides clues for a better understanding of pathological gamblers.