Early developments in the ability to understand the relation between stimulus and reward

Delayed nonmatching to sample (DNMS) is used to test the recognition memory function dependent on the medial temporal lobe. Children cannot succeed on this task until about 21 months. Because robust recognition is present well before then, the late emergence of another ability must account for the late success on DNMS. Evidence is presented here that the critical late-maturing competence is the ability to grasp the relation between stimulus and reward--that is, to understand that the stimulus is a symbol or marker for the reward. Infants of 9 and 12 months were tested on 3 conditions of DNMS. A sample object was presented. After a delay, the sample and a novel object appeared; choice of the novel object was rewarded. In the standard task, the reward was in a well beneath the stimulus. In the verbal-reward condition the reward was not a separate object but was praise and applause. In the Velcro condition, the reward, although a separate and separable object, was attached to the base of the stimulus. Most infants at both ages succeeded in the verbal-reward and Velcro conditions but not in the standard condition.     

Investment in body image among patients diagnosed with or at risk for malignant melanoma

We examined investment in body image among 48 patients diagnosed with, or at risk for malignant melanoma (MM), as well as factors hypothesized as related to increased investment, such as gender, perceived stress, mood, fatigue, and personality characteristics. Investment in body image was evaluated using the Measure of Body Apperception [Carver, C. S., Pozo-Kaderman, C., Price, A. A., Noriega, V., Harris, S. D., Derhagopian, R. S., Robinson, D. S., & Moffat, F. L. Jr. (1998). Concern about aspects of body image and adjustment to early state breast cancer. Psychosomatic Medicine, 60, 168–174]. Results showed that women reported more concerns about physical appearance than men, and patients with MM exhibited more concerns about body integrity than at-risk patients. Concerns about body integrity were related to more compulsive personality characteristics, whereas concerns about appearance were associated with more histrionic personality characteristics. Body image investment was related to poorer adjustment as indicated by heightened symptoms of fatigue and stress. This study suggests that further research on investment in body image in this patient population is warranted.     

Neuropsychopharmacologic treatment of depression and other neuropsychiatric disorders in HIV-infected individuals

How can neuropsychiatric disorders and syndromes be underdiagnosed and inadequately treated in individuals infected with human immunodeficiency virus? Depression in particular is among the most prevalent diagnoses and there is a solid foundation of data from controlled clinical studies that has begun to examine the efficacy of various antidepressants in HIV-infected persons. This article summarizes essential findings pertaining to the use of psychotropic medications to treat depression and other neuropsychiatric disorders in the context of immunodeficiency. This includes discussion of clinically significant treatment considerations (eg, efficacy, side effects, drug-drug interactions) derived from the existing literature. Taken together, there is compelling evidence that psychopharmacologic intervention can improve the quality of life of mentally ill HIV-infected individuals.     

Utility of the Millon Behavioral Medicine Diagnostic (MBMD) to predict adherence to highly active antiretroviral therapy (HAART) medication regimens among HIV-positive men and women

Psychosocial and behavioral factors may be strong predictors of adherence to medications in a wide variety of diseases. Newly emerging antiretroviral medications for HIV have been shown to be effective but require near perfect adherence to offer clinically significant benefits. There is currently great interest in deriving patient factors that may predict optimal medication adherence in HIV-positive persons. In this study, we examined the association of psychosocial and behavioral characteristics using the Millon Behavioral Medicine Diagnostic (MBMD; Millon, Antoni, Millon, Meagher, & Grossman, 2001) and adherence to highly active antiretroviral therapy (HAART) among 117 HIV-positive individuals on HAART regimens. Specific indexes of the MBMD were associated with HAART adherence as assessed through patient interview, at baseline assessment, and at 3-month follow-up at a point after which participants had received medication adherence training. As hypothesized, the Medication Abuse scale of the MBMD was uniquely associated with overall adherence at baseline assessment and also predictive of adherence at 3-month follow-up. Additional MBMD scales were also related to overall adherence as well as specific adherence behaviors such as missed doses, following specific instructions, and overmedicating, although the Medication Abuse scale emerged as the most consistent predictor of adherence in the study. These results suggest that the MBMD can be used to predict adherence to HAART medication in a sample of HIV-positive men and women and may subsequently be used to identify those in need of adherence counseling at the point when medications are initiated.     

Millon Behavioral Medicine Diagnostic (MBMD) Predicts Health-Related Quality of Life (HrQoL) Over Time Among Men Treated for Localized Prostate Cancer

Prostate cancer treatment presents multiple challenges that can negatively affect health-related quality of life (HrQoL), and that can be further compromised by maladaptive personality styles and psychological adjustment difficulties. This study examined the utility of a comprehensive psychosocial screening tool to identify psychosocial traits that prospectively predict HrQoL status among men treated for localized prostate cancer. The Millon Behavioral Medicine Diagnostic (MBMD) was administered to 66 men (M age = 68 years, 59% White) treated by either radical prostatectomy or radiotherapy along with standard measures of general and prostate-cancer-specific quality of life assessed at a 12-month follow-up. Higher scores on both summary MBMD Management Guides (Adjustment Difficulties and Psych Referral) and higher scores on personality styles characterized by avoidance, dependency, depression, passive aggressiveness, and self-denigration predicted lower HrQoL (β range = –.21 to –.50). Additionally, higher scores on the MBMD Depression, Tension-Anxiety, and Future Pessimism scales predicted lower HrQoL. Finally, higher scores on the MBMD Intervention Fragility and Utilization Excess scale also consistently predicted poorer mental and physical health functioning over time. These results point to the utility of the MBMD to help screen for potential impairments in mental and physical health functioning in men undergoing treatment for prostate cancer.     

Depression and HIV infection: impact on immune function and disease progression

Can psychological factors, such as depression, affect human immunodeficiency virus progression? HIV infection is viewed as a chronic illness in which those infected often confront a number of emotional challenges and physical health and disease-related issues. Over the past 20 years, there has been increasing evidence that depression and other mood-related disturbances are commonly observed among HIV-positive individuals. There is also mounting data showing that depressive symptoms might further impact upon specific elements of immune system functioning and influence quality of life and health status. This paper will highlight studies examining the prevalence of depression during HIV infection and review some of the evidence examining the impact of depressive symptoms on immune function and HIV disease progression.     

Cognitive-behavioral stress management increases free testosterone and decreases psychological distress in HIV-seropositive men.

The effects of a 10-week group-based cognitive-behavioral stress management (CBSM) intervention on psychological distress and plasma free testosterone in symptomatic, HIV-seropositive men were examined. Participants were randomized to either CBSM (n = 42) or a wait-list control group (n = 23). Men in the CBSM intervention showed significant increases in testosterone, whereas control participants showed significant decreases. Those participating in CBSM had significant distress reductions, whereas controls showed no such change. Alterations in free testosterone were inversely related to changes in distress states over time, independent of any changes in cortisol. These findings demonstrate that a short-term CBSM intervention increases free testosterone levels among symptomatic, HIV-seropositive men, and alterations in free testosterone are associated with changes in psychological distress observed during CBSM.     

Helping children apply their knowledge to their behavior on a dimension-switching task

To investigate why 3-year-olds have difficulty in switching sorting dimensions, children of 3 and 4 years were tested in one of four conditions on Zelazo's card sort task: standard, sleeve, label and face-up. In the standard condition, children were required to sort blue-truck and red-star cards under either a blue-star or red-truck model card, first by color or shape, and then by the other dimension. Here 3-year-olds sorted correctly until the dimension changed; they continue to sort by the initial dimension. The sleeve condition (placing the sorting cards in an envelope prior to sorting) had little effect. In the label condition, the child labeled the relevant sorting dimension on each trial. Most 3-year-olds succeeded; evidently their labeling helped them refocus their attention, overcoming ‘attentional inertia’ (the pull to continue attending to the previously relevant dimension). In the face-up condition, attentional inertia was strengthened because sorted cards were left face-up; 4-year-olds performed worse than in the standard condition. We posit that attentional inertia is the core problem for preschoolers on the card sort task.     

Utility of the Millon Behavioral Medicine Diagnostic (MBMD) to Predict Adherence to Highly Active Antiretroviral Therapy (HAART) Medication Regimens Among HIV-Positive Men and Women

Trait loyalty has received virtually no attention from researchers; consequently, the basic goal of this research was to create a measure of interpersonal loyalty. Principal factor analyses of an initial pool of items revealed 2 factors: Individual Loyalty (e.g., “I stand by my friends, even when they make mistakes”) and Group Loyalty (e.g., “I am loyal to my country”). Analyses of a revised item pool identified the same 2 factors in a second sample. Scales based on these factors were internally consistent and only moderately related to one another. Additional analyses indicated that both scales (a) were stable over time; (b) showed moderate to strong self-peer agreement; (c) positively correlated with conscientiousness, agreeableness, altruism, and positive emotionality; and (d) negatively related to an avoidant attachment style. However, these associations all were moderate in magnitude (in fact, none was as high as |.40|), indicating that the Individual and Group Loyalty Scales tap unique variance that is not captured by existing instruments.     

Using the Millon Behavioral Medicine Diagnostic (MBMD) to Evaluate the Need for Mental Health Services in Association with Biomarkers of Disease Status Among HIV Positive Men and Women

Psychological distress states have been related to rate of disease progression among HIV-positive individuals. However, the measures that have been used in this research as well as the treatment context of the populations studied are highly variable, making it challenging for clinicians to incorporate such measures into screening batteries. The present study examined the association of two summary scales of the Millon Behavioral Medicine Diagnostic (MBMD; Millon et al., Millon Behavioral Medicine Diagnostic. NCS Assessments, Minneapolis, 2001), with markers of HIV disease status (CD4 and CD8 cell counts, viral load) among an ethnically diverse sample of 147 HIV-positive individuals (52 men who have sex with men, 34 men who have sex with women, and 51 women) who had recently initiated Highly Active Antiretroviral Therapy (HAART). After controlling for age and months since HIV diagnosis, we found that higher scores on the overall MBMD Psych Referral Summary Scale, reflecting a need for mental health treatment, were related to greater HIV viral load but did not relate to CD4 or CD8 cell counts. Subgroup analyses revealed that Psych Referral scores were related to greater HIV viral load only for the men who have sex with men (MSM) subgroup. These results suggest that the MBMD may help in identifying psychosocial characteristics associated with some markers of disease status in persons with HIV and perhaps may also be useful in identifying individual differences in response to treatment and eventual disease outcome.