Longitudinal prescribing patterns of psychotropic drugs in nursing home residents.

Changes in the use of psychotropic drugs in a large nursing home were examined both in terms of usage for the total facility and in longitudinal changes within individuals. Data for the nursing home showed a gradual increase in use of antidepressants; a decrease in use of antianxiety medications and of sedative-hypnotics. Changes in the number of residents prescribed antipsychotics were not marked. Data within residents showed a great variability in number of psychotropic drugs used, in number of changes in dosage, and in specific patterns of medication change. The first drug change after admission (excluding day of admission) was more likely to involve initiation rather than discontinuation of psychotropic drugs. The medications studied were used over 4–7 months on the average, covering 20–30% of the resident's nursing home stay. The findings suggest that there is continued monitoring of psychotropic medications in the nursing home. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Medications prescribed for children with mood disorders: Effects of a family-based psychoeducation program.

Few controlled trials have examined psychotropic medications in children with mood disorders. Multiple medications are often prescribed for these children, who frequently suffer from several comorbid conditions. However, this polypharmacy has been infrequently studied and may lead to adverse drug-drug interactions. Multi-Family Psychoeducation Groups (MFPGs) are an 8-session, manual-driven treatment for children with mood disorders, designed as an adjunct to current medications and psychotherapy. In part, MFPG teaches parents and children to be better consumers of mental health care, including medications. This study examined the effect of MFPG on medications taken by 165 children, ages 8-11, with mood disorders. The authors hypothesized that MFPG would not affect the mean number of medications taken but that the variance in number of medications would decrease from pre- to posttreatment (i.e., the number of medications prescribed for any given child should become more closely distributed around the sample mean). Approximately 70% of participants were diagnosed with bipolar spectrum disorders, and 30% were diagnosed with depressive spectrum disorders. Most had both comorbid behavioral (97%) and anxiety (69%) disorders. Information regarding medications was gathered 4 times: at baseline, 6, 12, and 18 months. Approximately half (n=78) of the participants were randomized into immediate treatment, and half (n=87) were randomized into a 1-year wait-list condition. All were encouraged to continue treatment as usual throughout the study. As hypothesized, no significant pre- to posttreatment differences were found between groups for the mean number of current medications, but variance declined significantly from pre- to posttreatment. Implications and future research goals are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Persistent effect of incubation temperature on stress-induced behavior in the Yucatan banded gecko (Coleonyx elegans).

Although variability in behavioral traits within animal populations is well documented, the mechanisms maintaining that variability are still insufficiently known. In this study, we examined whether differences in thermal environment during egg incubation can permanently organize nonsocial behavior across different contexts and situations in a lizard species. We incubated eggs of the Yucatan banded gecko, Coleonyx elegans (Squamata: Gekkota: Eublepharidae) at 3 constant temperatures (26, 28, and 30 °C) and raised juveniles separately under the same conditions until adulthood. We then subjected them to 3 behavioral tests within 2 different contexts: an open-field test and a test of antipredator behavior (stressful context) as well as a test of feeding behavior (nonstressful context). Individuals of both sexes incubated at 30 °C were consistently less active and showed lower frequencies of several stereotypic behaviors in the stressful contexts than did individuals incubated at 26 and 28 °C. The test of feeding behavior revealed no significant effect of incubation temperature on geckos' behavior. Thus, our study demonstrates that developmental plasticity may play an important role in producing variability in stress-induced behavior in lizards. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Recent Advances in Pharmacotherapies for the Externalizing Disorders.

This article provides a review of various psychotropic agents employed for children and adolescents with externalizing disorders. With the exception of the stimulants, clinical use of psychotropic medications for children with externalizing disorders far exceeds the available empirical literature. Further, there are insufficient data pertaining to the safety and efficacy of most psychotropics. Studies that examine the combination of psychotherapy and pharmacotherapy are also reviewed, with particular attention to the National Institutes of Health Multimodal Treatment Study for Children with Attention-Deficit/Hyperactivity Disorder. Recommendations are made for future multimodal studies all externalizing disorders and with all psychotropics in addition to the stimulants. Future goals for research over the next decade include studies that examine treatment acceptability, adherence and satisfaction, adherence with various psychotropic agents, and ecologically valid investigations of pharmacotherapies for both symptom reduction and enhancement of functional behaviors among children and adolescents with externalizing behavioral problems. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The combined effects of memantine and fluoxetine on an animal model of obsessive compulsive disorder.

Obsessive Compulsive Disorder (OCD) is currently treated with behavioral modification and psychotropic medications, with varying degrees of success. The most popular drugs for the treatment of OCD are the selective serotonin reuptake inhibitors (SSRIs). Another drug, the N-methyl-d-aspartate antagonist memantine, has recently been tested in the treatment of OCD. The present study investigates the effect of fluoxetine and memantine alone and in combination in a mouse model of compulsive behavior. In this model, compulsive scratching is induced by a subcutaneous injection of serotonin or a serotonin releasing agent, compound 48–80, in the back of the neck. The effects of the memantine and fluoxetine combination were found to synergistic, specifically as defined by an isobologram. The results of the present investigation suggest the potential of a more effective management of the symptoms of OCD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social competence is reduced in socially deprived rhesus monkeys (Macaca mulatta).

Rhesus monkeys deprived for some period from their mother have often served as a model for the effect of adverse rearing conditions on social competence in humans. Social competence is the capacity to react in a species-specific way to social interactions. The current study assesses whether early deprivation from peers also affects the rates of behavior and social competence in rhesus monkeys. This was studied in groups of rhesus monkeys with different rearing conditions: subadult females that were mother-only reared during their first year of life and subsequently housed with peers were compared with subadult females from five naturalistic social groups. Socially deprived monkeys showed higher rates of submission and stereotypic behaviors than socially reared individuals. In addition, they show socially incompetent behavior, since they react with agonistic behavior to nonthreatening social situations. The results suggest that this socially incompetent behavior is rooted in a general feeling of anxiety toward group companions. The authors hypothesize that anxiety negatively affects social information processing, which results in socially incompetent behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting walking intentions and exercise in individuals with intermittent claudication: An application of the theory of planned behavior.

Objective: To identify determinants of intention and walking activity among individuals with intermittent claudication using the theory of planned behavior. Study Design and Participants: Prospective, correlational study of men and women (n = 62) with intermittent claudication. Method: Baseline questionnaire assessing theory of planned behavior measures regarding walking. Telephone follow-up assessing frequency and duration of walking during the previous week. Results: Attitudes, subjective norms, and perceived behavioral control explained 67% of the variance in intentions. Perceived behavioral control explained 8% of the variance in walking activity. Conclusion: Findings support the theory of planned behavior for predicting intentions and warrant future examination of perceived behavioral control as a determinant of exercise. A basis for developing interventions to facilitate walking among this population is provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Longitudinal effects of adaptability on behavior problems and maternal depression in families of adolescents with autism.

Research on families of individuals with autism has tended to focus on child-driven effects utilizing models of stress and coping. The current study used a family systems perspective to examine whether family level adaptability promoted beneficial outcomes for mothers and their adolescents with autism over time. Participants were 149 families of children diagnosed with autism who were between the ages of 10 and 22 years during the 3-year period examined. Mothers reported on family adaptability, the mother–child relationship, their own depressive symptoms, and the behavior problems of their children at Wave 1, and these factors were used to predict maternal depression and child behavior problems 3 years later. Family level adaptability predicted change in both maternal depression and child behavior problems over the study period, above and beyond the contribution of the dyadic mother–child relationship. These associations did not appear to depend upon the intellectual disability status of the individual with autism. Implications for autism, parent mental health, family systems theory, and intervention with this population are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Pharmacologic management of psychiatric illness during pregnancy: dilemmas and guidelines

OBJECTIVE: Given concerns about use of psychotropic medication during pregnancy, the authors reviewed the literature regarding the effects of prenatal exposure to psychotropic medications on fetal outcome. METHOD: A MEDLINE search of all articles written in English from 1966 to 1995 was performed to review information on the effects of psychotropic drug use during pregnancy on fetal outcome. Where sufficient data were available and when methodologically appropriate, meta-analyses were performed to assess risk of fetal exposure by psychotropic medication class. RESULTS: Three primary effects are associated with medication use during pregnancy: 1) teratogenicity, 2) perinatal syndromes (neonatal toxicity), and 3) postnatal behavioral sequelae. For many drug classes there are substantial data regarding risk for teratogenicity. Tricyclic antidepressants do not seem to confer increased risk for organ dysgenesis. The available data indicate that first-trimester exposure to low-potency phenothiazines, lithium, certain anticonvulsants, and benzodiazepines may increase the relative risk for congenital anomalies. However, the absolute risk of congenital malformations following prenatal exposure to most psychotropics is low. CONCLUSION: Exposure to certain psychotropic drugs in utero may increase the risk for some specific congenital anomalies, but the rate of occurrence of these anomalies even with the increased risk remains low. Use of psychotropic medications during pregnancy is appropriate in many clinical situations and should include thoughtful weighing of risk of prenatal exposure versus risk of relapse following drug discontinuation. The authors present disorder-based guidelines for psychotropic drug use during pregnancy and for psychiatrically ill women who wish to conceive.     

Psychopharmacology of aggression in children and adolescents with primary neuropsychiatric disorders: A review of current and potentially promising treatment options.

Research examining the role of pharmacological therapy in the treatment of children and adolescents with clinical disorders is growing. Clinical disorders that present with comorbid aggression can add a challenge to treatment. Child and adolescent neuropsychiatric disorders associated with aggression include attention-deficit hyperactivity disorder, various mood disorders and in particular bipolar disorders/pediatric mania, schizophrenia, mental retardation, oppositional defiant disorder, conduct disorder, and autism spectrum disorders. This review describes the psychopharmacy to treat these disorders and the aggression that often appears comorbidly. Existing literature regarding the efficacy and safety of psychotropics for youth with neuropsychiatric disorders also is discussed. In addition, general guidelines for psychopharmacy of aggression in children and adolescents are presented. Studies reviewed in this article provide evidence for the use of psychostimulants, alpha-2 agonists, beta blockers, lithium, anticonvulsant mood-stabilizers, atypical antipsychotics, traditional antipsychotics, and selective serotonin reuptake inhibitors in treating pediatric aggression with the choice of medication dependent on symptomology. Despite increased support for pediatric psychotropic use, there is a need for more long-term safety and efficacy studies of existing medications and newer, safer, and more effective agents with fewer side effects for the pharmacological treatment of all childhood disorders in which aggression is prominent. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral approaches to the treatment of early infantile autism: A review.

Examines and evaluates behavioral approaches to the treatment of early infantile autism. Attempts to modify such diverse targets as self-destructive behavior, tantrums, aggressive and disruptive behavior, self-stimulation, toilet training, eye contact, imitation, verbal skills, prosocial behavior, and classroom activity are presented. Issues including proper diagnosis, etiology, and generalization are discussed. It is concluded that although the level of product has been generally less than experimental (or quasi-experimental) in nature, there is reason to believe that behavioral intervention has been associated with real behavior change. (91 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emotional conditions disrupt behavioral control among individuals with dysregulated personality traits.

The current study directly examined emotion-induced behavior dyscontrol among individuals scoring high on dysregulated tendencies, represented by impulsive-antisocial and borderline personality traits, using an emotional–linguistic go/no-go laboratory paradigm (Goldstein et al., 2007). We specifically examined the effects of these personality traits and emotional context on (a) overall behavior dyscontrol (slower reaction times [RTs] to emotional blocks relative to neutral blocks) and (b) duration of the dyscontrol (persistence or habituation of the effect of emotional context on behavior across blocks). We hypothesized that individuals high on borderline-antisocial traits would exhibit greater behavioral dyscontrol (slower RTs or lack of habituation across blocks) when responding during blocks of negative emotional cues. We also examined whether this emotional effect on behavioral control would be exacerbated by exposure to particularly salient emotional stimuli (diagnostically relevant negative affective words; e.g., abandon). Results indicated that high borderline-antisocial individuals showed greater initial behavioral control difficulties (slower RTs) to general negative affective words than to other word contents during the first block of trials, but this effect habituated by the second block. Importantly, slowed responses to diagnostically relevant word blocks persisted across time among high borderline-antisocial individuals, whereas low scorers showed habituated behavioral responses to emotional words across time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Facial affect recognition training in autism: Can we animate the fusiform gyrus?

One of the most consistent findings in the neuroscience of autism is hypoactivation of the fusiform gyrus (FG) during face processing. In this study the authors examined whether successful facial affect recognition training is associated with an increased activation of the FG in autism. The effect of a computer-based program to teach facial affect identification was examined in 10 individuals with high-functioning autism. Blood oxygenation level-dependent (BOLD) functional magnetic resonance imaging (fMRI) changes in the FG and other regions of interest, as well as behavioral facial affect recognition measures, were assessed pre- and posttraining. No significant activation changes in the FG were observed. Trained participants showed behavioral improvements, which were accompanied by higher BOLD fMRI signals in the superior parietal lobule and maintained activation in the right medial occipital gyrus. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomized, double-blind placebo-controlled trial of coenzyme Q10 in patients with acute myocardial infarction

Adherence with inhaled beta-agonists and corticosteroids in 24 asthmatic children was tracked over 3 months utilizing the metered-dose inhaler chronolog (MDIC). Patients seldom took all of their medications as prescribed, and failed to take any inhaled corticosteroid doses on a median of 41.8% of days or inhaled beta-agonists on 28.1% of days despite prescribed daily use. Medication nonadherence was correlated with lower levels of asthma knowledge (Asthma Knowledge Questionnaire) and family dysfunction (Family Assessment Device), but not child behavior disorder (Child Behavior Checklist). Patients tended to dramatically over-report medication use. Improved identification of the markers of nonadherence can directly facilitate more efficient targeting of behavioral interventions, resulting in improved adherence, better illness control, and less requirement of urgent medication intervention.     

A contextual behavioral approach to the role of emotion in psychotherapy supervision.

As behavior therapy expands to address problems related to private events, appropriate methods of supervision must be developed to train individuals to work with the full range of human experience, using a behavioral model. The authors suggest that therapists’ in-session emotions are an important source of information about the impact of clients’ behavior on others. Contextual behavior therapists may enhance their effectiveness in meeting clients’ needs by attending to the therapist’s own emotional responses. This paper provides a contextual behavioral rationale for including a focus on emotion in supervision, with a four-phase model for shaping early trainees’ ability to use their emotional reactions to facilitate therapy in a coherent manner. (PsycINFO Database Record (c) 2010 APA, all rights reserved)