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Congenital and acquired disorders presenting as psychosis in children and young adults

Tue, 09/16/2014 - 3:18pm

A review of the published literature found 60 congenital and acquired disorders with symptoms that include psychosis in youth. The prevalence, workup, genetics, and associated neuropsychiatric features of each disorder are described. Eighteen disorders (30%) have distinct phenotypes (doorway diagnoses); 18 disorders (30%) are associated with intellectual disability; and 43 disorders (72%) have prominent neurologic signs. Thirty-one disorders (52%) can present without such distinct characteristics, and are thus more easily overlooked. A systematic and cost-effective differential diagnostic approach based on estimated prevalence and most prominent associated signs is recommended.

Predictive accuracy in the neuroprediction of rearrest

Tue, 09/16/2014 - 3:18pm

A recently published study by the present authors reported evidence that functional changes in the anterior cingulate cortex within a sample of 96 criminal offenders who were engaged in a Go/No-Go impulse control task significantly predicted their rearrest following release from prison. In an extended analysis, we use discrimination and calibration techniques to test the accuracy of these predictions relative to more traditional models and their ability to generalize to new observations in both full and reduced models. Modest to strong discrimination and calibration accuracy were found, providing additional support for the utility of neurobiological measures in predicting rearrest.

Changes in pro-inflammatory cytokines and body weight during 6-month risperidone treatment in drug naive, first-episode schizophrenia

Tue, 09/16/2014 - 3:18pm

OBJECTIVE: The present study aimed to examine the changes in pro-inflammatory cytokines and body weight during 6-month risperidone treatment in drug naive, first-episode schizophrenia. METHODS: Sixty-two drug naive, first-episode schizophrenia (SZ group) and 60 healthy individuals (control group) were enrolled in the study. Serum interleukin-1beta (IL-1beta), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-alpha) levels, and body weight were measured at baseline for both groups, and repeated for the SZ group at five different time points during 6-month risperidone treatment. RESULTS: At baseline, serum IL-1beta, IL-6, and TNF-alpha levels in the SZ group (53.28 +/- 12.62, 33.98 +/- 14.13, 50.08 +/- 12.86 pg/mL, respectively) were significantly higher than those in the control group (23.49 +/- 15.27, 15.53 +/- 7.16, 32.12 +/- 15.23 pg/mL, respectively) (p's < 0.001). Within the SZ group, serum IL-1beta levels decreased significantly at 2 weeks (48.02 +/- 16.00 pg/mL, p < 0.01) and 1 month (44.70 +/- 16.63 pg/mL, p < 0.001), but then gradually increased at 2 months (48.49 +/- 18.87 pg/mL), 3 months (50.59 +/- 18.48 pg/mL) and 6 months (53.64 +/- 16.22 pg/mL) to the levels comparable to baseline; serum IL-6 levels changed significantly over the course of treatment (p = 0.001), but reached the levels comparable to baseline at 6 months (37.13 +/- 13.23 pg/mL); serum levels of TNF-alpha increased significantly at 3 months (55.02 +/- 16.69 pg/mL, p < 0.01) and 6 months (58.69 +/- 13.57 pg/mL, p < 0.001); steady and significant weight gain was observed at each follow-up time point (p's < 0.001), from 56.71 +/- 9.25 kg at baseline to 62.72 +/- 9.53 kg at 6 months. CONCLUSIONS: Risperidone treatment is associated with changes in serum pro-inflammatory cytokines levels and weight. There is an initial anti-inflammatory effect that reduces with treatment, potentially due to its weight gain side effect.

The NIH Toolbox Cognition Battery: results from a large normative developmental sample (PING)

Tue, 09/16/2014 - 3:18pm

OBJECTIVE: The NIH Toolbox Cognition Battery (NTCB) was designed to provide a brief, efficient computerized test of key neuropsychological functions appropriate for use in children as young as 3 years of age. This report describes the performance of a large group of typically developing children and adolescents and examines the impact of age and sociocultural variables on test performance. METHOD: The NTCB was administered to a sample of 1,020 typically developing males and females ranging in age from 3 to 20 years, diverse in terms of socioeconomic status (SES) and race/ethnicity, as part of the new publicly accessible Pediatric Imaging, Neurocognition, and Genetics (PING) data resource, at 9 sites across the United States. RESULTS: General additive models of nonlinear age-functions were estimated from age-differences in test performance on the 8 NTCB subtests while controlling for family SES and genetic ancestry factors (GAFs). Age accounted for the majority of the variance across all NTCB scores, with additional significant contributions of gender on some measures, and of SES and race/ethnicity (GAFs) on all. After adjusting for age and gender, SES and GAFs explained a substantial proportion of the remaining unexplained variance in Picture Vocabulary scores. CONCLUSIONS: The results highlight the sensitivity to developmental effects and efficiency of this new computerized assessment battery for neurodevelopmental research. Limitations are observed in the form of some ceiling effects in older children, some floor effects, particularly on executive function tests in the youngest participants, and evidence for variable measurement sensitivity to cultural/socioeconomic factors.

Influence of sex and menopausal status on response, remission, and recurrence in patients with recurrent major depressive disorder treated with venlafaxine extended release or fluoxetine: analysis of data from the PREVENT study

Tue, 09/16/2014 - 3:18pm

OBJECTIVE: To evaluate the effects of sex and menopausal status on acute-, continuation-, and maintenance-phase treatment outcomes in patients with recurrent major depressive disorder (MDD). METHOD: This was a secondary analysis of data from the Prevention of Recurrent Episodes of Depression With Venlafaxine for Two Years (PREVENT) trial, a multiphase, multicenter, double-blind study in which adult outpatients with recurrent MDD (by DSM-IV criteria) were randomly assigned to 10 weeks of acute-phase venlafaxine extended release (ER) (75-300 mg/d) or fluoxetine (20-60 mg/d). Patients achieving response or remission had 6 months of continuation-phase treatment. Responding or remitting patients in the venlafaxine ER group were randomly assigned to venlafaxine ER or placebo for 2 consecutive 12-month maintenance phases; fluoxetine-treated patients continued receiving fluoxetine. The outcome measures for this analysis were acute- and continuation-phase response and remission rates (as measured by the 17-item Hamilton Depression Rating Scale) and time to depression recurrence in the maintenance phases according to sex and menopausal status at baseline. RESULTS: The intent-to-treat population comprised 781 patients in the venlafaxine ER group (65% women) and 266 patients in the fluoxetine group (61% women); 64% of all women were premenopausal, and 25% were postmenopausal (5% perimenopausal; not analyzed). At acute-phase end, remission rates in the venlafaxine ER vs fluoxetine groups were 44% vs 47% in men, 51% vs 52% in women, 50% vs 52% in premenopausal women, and 52% vs 55% in postmenopausal women. At continuation-phase end, remission rates in the venlafaxine ER vs fluoxetine groups were 71% vs 74% in men, 72% vs 67% in women, 72% vs 69% in premenopausal women and 71% vs 63% in postmenopausal women. Response rates were consistent with these findings. Based on a Cox proportional hazards model, sex was not a significant predictor of recurrence during the first or second maintenance phase (hazard ratio [HR] = 1.233; P = .3712 and HR = 1.103; P = .8075, respectively), and neither was menopausal status at acute-phase baseline (HR = 0.941; P = .8234 and HR = 0.531; P = .2065, respectively). CONCLUSIONS: In this study of patients with recurrent MDD, treatment outcomes with venlafaxine ER and fluoxetine did not differ on the basis of sex or menopausal status. Our confidence in these findings is limited by the lack of a placebo arm during the acute and continuation phases and by the small sample sizes for subgroup analyses in the maintenance phases. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00046020.

Structure-centered portal for child psychiatry research

Tue, 09/16/2014 - 3:18pm

The real world needs of the clinical community require a domain-specific solution to integrate disparate information available from various web-based resources for data, materials, and tools into routine clinical and clinical research setting. We present a child-psychiatry oriented portal as an effort to deliver a knowledge environment wrapper that provides organization and integration of multiple information and data sources. Organized semantically by resource context, the portal groups information sources by context type, and permits the user to interactively "narrow" or "broaden" the scope of the information resources that are available and relevant to the specific context. The overall objective of the portal is to bring information from multiple complex resources into a simple single uniform framework and present it to the user in a single window format.

Psychopathic traits modulate brain responses to drug cues in incarcerated offenders

Tue, 09/16/2014 - 3:18pm

Recent neuroscientific evidence indicates that psychopathy is associated with abnormal function and structure in limbic and paralimbic areas. Psychopathy and substance use disorders are highly comorbid, but clinical experience suggests that psychopaths abuse drugs for different reasons than non-psychopaths, and that psychopaths do not typically experience withdrawal and craving upon becoming incarcerated. These neurobiological abnormalities may be related to psychopaths' different motivations for-and symptoms of-drug use. This study examined the modulatory effect of psychopathic traits on the neurobiological craving response to pictorial drug stimuli. Drug-related pictures and neutral pictures were presented and rated by participants while hemodynamic activity was monitored using functional magnetic resonance imaging. These data were collected at two correctional facilities in New Mexico using the Mind Research Network mobile magnetic resonance imaging system. The sample comprised 137 incarcerated adult males and females (93 females) with histories of substance dependence. The outcome of interest was the relation between psychopathy scores (using the Hare Psychopathy Checklist-Revised) and hemodynamic activity associated with viewing drug-related pictures vs. neutral pictures. There was a negative association between psychopathy scores and hemodynamic activity for viewing drug-related cues in the anterior cingulate, posterior cingulate, hippocampus, amygdala, caudate, globus pallidus, and parts of the prefrontal cortex. Psychopathic traits modulate the neurobiological craving response and suggest that individual differences are important for understanding and treating substance abuse.

The relationship between change in apathy and changes in cognition and functional outcomes in currently non-depressed SSRI-treated patients with major depressive disorder

Tue, 09/16/2014 - 3:18pm

AIMS: Apathy in the context of treated major depressive disorder (MDD) is a frequently observed phenomenon in clinical practice. This study aimed to assess the validity of the Rothschild Scale for Antidepressant Tachyphylaxis(R) (RSAT) and the Massachusetts General Hospital Cognitive and Physical Functioning Questionnaire (CPFQ) for measuring apathy, and to assess the relationship between apathy and possible contributing factors, in patients with MDD and residual apathy in the absence of depressed mood. METHODS: The underlying structure and validity of the RSAT and CPFQ were assessed via factor analysis and correlation with the Apathy Evaluation Scale-Clinician rated version (AES-C) in 483 patients who had previously responded to treatment with a selective serotonin reuptake inhibitor. The relationship between apathy and contributing variables was investigated via structural equation modeling. Correlation and regression analyses were conducted to examine the relationship between the Sheehan Disability Scale (SDS) and the RSAT, CPFQ, and AES-C. RESULTS: The RSAT and CPFQ were validated with the AES-C with respect to energy and motivation. The latent variable "Energy and Interest", based on the energy, motivation, and interest items (RSAT and CPFQ), was a major contributing factor to apathy. Improvements in function (SDS) were significantly correlated with, and predicted by, improvements in apathy and cognitive and physical functioning (assessed by the RSAT, CPFQ, and AES-C). CONCLUSIONS: These analyses provide further information on apathy and its assessment in the context of treated MDD. A better understanding of apathy will aid further investigation of this phenomenon and, ultimately, determination of the most appropriate approach for its clinical management.

The Development of Comorbid Conduct Problems in Children With ADHD: An Example of an Integrative Developmental Psychopathology Perspective

Tue, 09/16/2014 - 3:18pm

Objective: We describe interactions among factors that contribute to the development of conduct problems among children with ADHD. Method: An integrative developmental psychopathology analysis combines various approaches and posits one model of how diverse risk factors operate together to contribute to the development of conduct problems among children with ADHD. Results: Substantial genetic risk increases covariation between ADHD and conduct problems. Candidate genes are associated with CNS monoaminergic neurotransmission. Subsequent neurodevelopmental impairment interferes with executive function, with impaired verbal working memory playing an important role. Parent/child bi-directional influences exacerbate the risk for conduct problems when ADHD symptoms increase the likelihood of a coercive parenting style. Parent stress in reaction to child comorbid ADHD and conduct problems, and parent attribution for the child's conduct problem behavior, add to the potential for coercion and reduce constructive parent-child interaction that might otherwise enhance the development of verbal working memory. Conclusion: In an integrated manner, these variables increase the risk that a child with ADHD will subsequently develop conduct problems. (J. of Att. Dis. 2013; XX(X) 1-XX).

Exploring Knowledge Exchange at the Research-Policy-Practice Interface in Children's Behavioral Health Services

Tue, 09/16/2014 - 3:18pm

This case study explored core components of knowledge exchange among researchers, policymakers, and practitioners within the context of the Rosie D. versus Romney class action lawsuit in Massachusetts and the development and implementation of its remedial plan. We identified three distinct, sequential knowledge exchange episodes with different purposes, stakeholders, and knowledge exchanged, as decision-making moved from Federal Medicaid policy to state Medicaid program standards and to community-level practice. The knowledge exchanged included research regarding Wraparound, a key component of the remedial plan, as well as contextual information critical for implementation (e.g., Federal Medicaid policy, managed care requirements, community organizations' characteristics).

Enhancement in cognitive function recovery by granulocyte-colony stimulating factor in a rodent model of traumatic brain injury

Tue, 09/16/2014 - 3:18pm

Traumatic brain injury (TBI) is characterized by neuronal damage and commonly, secondary cell death, leading to functional and neurological dysfunction. Despite the recent focus of TBI research on developing therapies, affective therapeutic strategies targeting neuronal death associated with TBI remain underexplored. This study explored the efficacy of granulocyte-colony stimulating factor (G-CSF) as an intervention for improving cognitive deficits commonly associated with TBI. Although G-CSF has been studied with histological techniques, to date, its effects on functional outcome remain unknown. To this end, we used a closed head injury (CHI) model in Wistar rats that were randomly assigned to one of four groups (untreated TBI, G-CSF treated TBI, G-CSF treated Control, Control). The treatment groups were administered subcutaneous injections of G-CSF 30 min (120 mug/kg) and 12 h (60 mug/kg) post-trauma. The Morris Water Maze test was used to measure any treatment-associated changes in cognitive deficits observed in TBI animals at days 2-6 post-injury. Our findings demonstrate a significant improvement in cognitive performance in the G-CSF treated TBI animals within a week of injury, compared to untreated TBI, indicative of immediate and beneficial effect of G-CSF on cognitive performance post CHI. Our model suggests that early G-CSF exposure may be a promising therapeutic approach in recovery of cognitive deficits due to TBI.

A DSM-5 to-do list for adult psychiatry residency directors

Tue, 09/16/2014 - 3:18pm

A small study within the author's department, comparing resident and faculty attitudes toward the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), revealed that the DSM-5 transition process is starting from a point in which neither faculty nor residents are optimistic that the new DSM will result in improved diagnosis or treatment. However, the publication of DSM-5 presents training directors with opportunities to engage trainees in the study of the evolution of psychiatric nosology and the evidence for core psychiatric diagnoses. Residents should be encouraged to become familiar with both DSM-5 and National Institute of Mental Health Research Domain Criteria (NIMH RDoC) categories in their study of the neurobiology of psychiatric disorders. Department chairs are encouraged to establish timelines for the DSM-5 transition for faculty, residents, medical student teaching, medical record keeping, and billing for services. Training directors should be aware that national examinations for trainees will transition gradually between 2014 and 2017, so comparisons should be made whenever possible between DSM-IV-TR and DSM-5. To minimize trainee confusion, departments should attend to the coherence of transition timelines among faculty, resident, and medical student training.

Implementing an intervention for parents with mental illness: Building workforce capacity

Tue, 09/16/2014 - 3:18pm

OBJECTIVE: This article describes the challenges in building workforce capacity when implementing an intervention for families living with parental mental illnesses. METHOD: Data were obtained in the context of a larger, developmental, mixed-methods study. Participants included all agency employees working with families in the Family Options intervention on a daily basis. In-depth interviews were representative of the implementation time frame and activities, and the range of staff members' roles and involvement in the implementation process. Themes emerged as interview transcripts were coded qualitatively using a constant comparative approach. RESULTS: Identifying complex family needs, anticipating the needs of children, and addressing staff needs for training and support were crucial considerations in implementing a family intervention. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: As the psychiatric rehabilitation field acknowledges the impact of family life on adults as well as children, and moves toward family informed services, knowledge of how to shape and support this specialized workforce is essential. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

The role of coping in depression treatment utilization for VA primary care patients

Tue, 09/16/2014 - 3:18pm

OBJECTIVE: To examine the impact of Veterans' coping strategies on mental health treatment engagement following a positive screen for depression. METHODS: A mixed-methods observational study using a mailed survey and semi-structured interviews. Sample included 271 Veterans who screened positive for depression during a primary care visit at one of three VA medical centers and had not received a diagnosis of depression or prescribed antidepressants 12 months prior to screening. A subsample of 23 Veterans was interviewed. RESULTS: Logistic regression models showed that Veterans who reported more instrumental support and active coping were more likely to receive depression or other mental health treatment within three months of their positive depression screen. Those who reported emotional support or self-distraction as coping strategies were less likely to receive any treatment in the same time frame. Qualitative analyses revealed that how Veterans use these and other coping strategies can impact treatment engagement in a variety of ways. CONCLUSIONS: The relationship between Veterans' use of coping strategies and treatment engagement for depression may not be readily apparent without in-depth exploration. PRACTICE IMPLICATIONS: In VA primary care clinics, nurse care managers and behavioral health providers should explore how Veterans' methods of coping may impact treatment engagement.

Risk factors for suicide among 34,671 patients with psychotic and non-psychotic severe depression

Tue, 09/16/2014 - 3:18pm

BACKGROUND: Severe unipolar depression is associated with increased risk of suicide, but it remains unknown whether the same risk factors are present in the non-psychotic (non-PD) and psychotic (PD) subtypes respectively. Therefore, this study aimed to identify risk factors for suicide in non-PD and PD separately, and to investigate if the presence of psychotic symptoms is an independent risk factor for suicide in severe depression. METHODS: This register-based, nationwide, historical prospective cohort study used logistic regression analyses to ascertain risk factors for suicide among all adults diagnosed with severe depression at Danish psychiatric hospitals between January 1, 1994 and December 31, 2010. The risk for suicide was expressed as adjusted odds ratios (AOR). RESULTS: A total of 34,671 individuals with severe depression (non-PD: n=26,106 and PD: n=12,101) were included in the study. Of these, 755 completed suicide during follow up. PD was not found to be an independent risk factor for suicide in severe depression (AOR=0.97 [0.83-1.15]). Older age (non-PD AOR=1.05 [per year], PD AOR=1.04 [per year]), male sex (non-PD AOR=1.89, PD AOR=1.98), and a previous incident of self-harm (non-PD AOR=5.02, PD AOR=5.17) were significant risk factors for both groups. LIMITATIONS: As the study population was comprised only of patients with contact to psychiatric hospitals, the results cannot be extrapolated to the primary care setting. CONCLUSION: The following risk factors for non-PD and PD were identified: older age, male gender and previous incidents of self-harm. In suicide prevention efforts, equal attention should be paid to non-PD and PD patients.

Introduction

Tue, 09/16/2014 - 3:18pm

Vagus Nerve Stimulation and Food Intake: Effect of Body Mass Index

Tue, 09/16/2014 - 3:18pm

Animal research suggests that vagus nerve stimulation (VNS) is associated with weight loss and decreased appetite. Results from human studies are mixed; some suggest that VNS affects weight whereas others do not, and it is unclear how VNS affects eating behaviors. Baseline body mass index (BMI) and VNS device settings may moderate the effects of VNS on caloric intake. This study investigates the association among BMI, VNS device settings, and caloric intake of highly palatable foods during VNS on versus VNS off sessions in 16 adult patients (62.5% female; BMI mean = 29.11 +/- 6.65) using VNS therapy for either epilepsy or depression. Participants attended 2 experimental sessions (VNS on versus off) where they were presented with 4 preferred snack foods totaling 1600 calories. At the start of the session, they either had their VNS devices turned off or left on. Caloric intake was calculated by weighing foods before and after each session. BMI category (overweight/obese and lean) was the between group factor in the analysis. After controlling for covariates, an interaction of condition and BMI category (P = .03) was found. There was an interaction of condition and device output current (P = .05) and a trend toward an interaction of condition and device on time (P = .07). Excess weight may impact how neurobiological signals from the vagus nerve affect appetite and eating. Future research is needed to further elucidate this relationship.

Appealing Features of Vocational Support Services for Hispanic and non-Hispanic Transition Age Youth and Young Adults with Serious Mental Health Conditions

Tue, 09/16/2014 - 3:18pm

Transition age youth and young adults (TAYYAs) diagnosed with serious mental health conditions (SMHCs) are at greater risk of being unemployed compared to their peers without SMHCs. Job counseling and job placement services are the greatest predictor of competitive employment, yet we have limited knowledge about what TAYYAs believe they need to obtain gainful employment. In person, qualitative interviews were conducted with 57 non-Hispanic and Hispanic TAYYAs with SMHCs enrolled in three vocational support programs in MA (Vocational Rehabilitation, Individual Placement and Support; the Clubhouse Model as described by the International Center for Clubhouse Development). Six themes emerged from the data: three themes were identified as social capital (supportive relationships, readily available workplace supports, and vocational preparation), two themes related to human capital (effective educational supports and work experience), and one theme related to cultural capital (social skills training). Unique features (Spanish-speaking staff and/or familiar in Latino culture, familial-like staff support) were frequently noted by Hispanic TAYYAs.