Therapy for youths with anxiety disorders: A second randomized clincal trial.

Ninety-four children (aged 9-13 years) with anxiety disorders were randomly assigned to cognitive behavioral treatment or waiting-list control. Outcomes were evaluated using diagnostic status, child self-reports, parent and teacher reports, cognitive assessment and behavioral observation; maintenance was examined using l-year follow-up data. Analyses of dependent measures indicated significant improvements over time, with the majority indicating greater gains for those receiving treatment. Treatment gains returned cases to within nondeviant limits (i.e., normative comparisons) and were maintained at l-year follow-up. Client age and comorbid status did not moderate outcomes. A preliminary examination of treatment segments suggested that the enactive exposure (when it follows cognitive-educational training) was an active force in beneficial change. Discussion includes suggestions for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development of antisocial personality disorder in detained youths: The predictive value of mental disorders.

Antisocial personality disorder (APD) is a serious public and mental health concern. Understanding how well conduct disorder (CD) and other mental disorders predict the development of APD among youths involved in the juvenile justice system is critical for prevention. The authors used a stratified random sample of 1,112 detained youths to examine the development of APD at a 3-year follow-up interview. Nearly one fifth of male juvenile detainees later developed APD; approximately one quarter of male juvenile detainees with CD at baseline later developed APD. Significantly more males than females developed APD; no differences were found by race/ethnicity. Having 5 or more symptoms of CD, dysthymia, alcohol use disorder, or generalized anxiety disorder was significantly associated with developing modified APD (M-APD; APD without the CD requirement). Some disorders were strong predictors of APD; however, none were adequate screeners for identifying which detainees would later develop M-APD. The findings of this study have implications for interventions and further research in developmental psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Homeostatic reconditioning in stress-related disorders: A preliminary study of migraine headaches.

18 19–55 yr old migraine headache patients were assigned to a group that learned (1) to raise finger temperature, via visual biofeedback, after neutral imaginal experiences or (2) to raise finger temperature after stressful imaginal experiences. At the completion of training, Ss participated in an outcome session without feedback. Laboratory training, combined with home practice using the same respective imaginal experiences, resulted in Ss' being able, with on-task concentration, to raise finger temperature without feedback and also resulted in significant clinical reductions in headache activity. Improvement was more marked at 4-wk follow-up. Ss trained in vascular recovery after stress showed more improvement than did other Ss. Overall, the Ss who showed the most reliable vascular recovery conditioning effects were those whose migraine prodromal symptomatology was not an accurate predictor of headache or absence of headache. The significance of what is called homeostatic reconditioning, after stress, in stress-related disorders, rather than the "aspirin" approach of many biofeedback treatments, is discussed. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethnic differences in the treatment of dual mental and substance disorders. A preliminary analysis

Via the refinement process of the monomer form of an arginine-vasopressin-like insect factor, the paper analyses the most relevant NMR information to define the solution structure of a flexible peptide. The relative importance of the different NOE constraints is discussed.     

Mantle-cell lymphoma: a population-based clinical study

PURPOSE: From a population-based non-Hodgkin's lymphoma (NHL) registry, 41 patients with mantle cell lymphoma (MCL) -- a recently defined distinct B-cell NHL -- were selected and compared with patients with low- or intermediate-grade NHL from the same registry. PATIENTS AND METHODS: The incidence and behavior of MCL in the area of the Comprehensive Cancer Center West (CCCW) from 1981 to 1989 were analyzed. Age, performance, tumor bulk, extranodal localization, stage, response to therapy, and survival were registered. Expression of cyclin D1 protein and Ki-67 were measured in 29 patients. RESULTS: MCL made up 3.7% of NHLs. The median age was 68 years, and the male-to-female ratio was 1.6:1. Seventy-eight percent presented with stage IV, with the majority having bone marrow involvement. The complete response (CR) rate was 32% (13 of 41), with a median duration of 25 months. The median overall survival time was 31.5 months. The International Prognostic Index identified five patients with a low-risk score and a median survival time of 93+ months. In 23 of 29 patients, cyclin D1 overexpression was present, without any relation to overall or disease-free survival. In contrast, a proliferative index less than 10% was significantly related to a better overall survival time (50 v 24 months). CONCLUSION: MCL is a disease of the elderly, who present with widespread disease and with a poor response to therapy. Although it harbors features of an indolent NHL, it behaves clinically as an aggressive NHL with a short overall survival time.     

One-session treatment of specific phobias in youths: A randomized clinical trial.

Sixty children, ages 7-17 years, who fulfilled Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) diagnosis for various specific phobias were randomized to (a) 1-session exposure treatment alone, (b) 1-session treatment with a parent present, or (c) wait-list control group for 4 weeks. After the waiting period, the wait-list patients were rerandomized to the active treatments. The patients' phobias were assessed with behavioral approach tests (approach behavior, experienced anxiety, and physiological reactions), whereas general anxiety, depression, phobic tendencies, and anxiety sensitivity were assessed with self-report inventories. Assessments were done pre-, post-, and 1-year following treatment. Results showed that both treatment conditions did significantly better than the control condition, whereas the treatment groups did equally well on most measures, and the effects were maintained at follow-up. The implications of these results are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Double jeopardy in the interrogation room for youths with mental illness.

Comments on the article by J. Owen-Kostelnik, N. D. Reppucci, and J. R. Meyer (see record 2006-05893-002) which reviewed the issues surrounding the police interrogation of minors. This commentary expands on the review by addressing the mental health status of youths who come into contact with police. It stems from two immutable facts: (a) The prevalence of mental illness among justice-involved youths is alarmingly high, and (b) mental illness by itself is a risk factor for false confession. These two facts place suspected youths in double jeopardy in the interrogation room. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A preliminary classification system for homeless veterans with mental illness.

The purpose of this study was that of defining psychiatric profiles among veterans based on a structured interview of 3,595 individuals administered by outreach mental health clinicians to individuals who were presently or recently homeless. The interview included ratings of presence or absence of current psychiatric disorders; alcoholism, drug abuse, psychosis, mood disorders, personality disorders, PTSD, and adjustment disorders. We identified three subgroups using cluster analysis each showing different diagnostic profiles that were characterized as "addiction" (n = 3,061), "psychosis" (n = 218), and "personality" disorders (n = 54). Cluster membership was related to demographic characteristics, living situation, length of homelessness, and symptoms and complaints including cognitive difficulties, suicidality, violence, and depression. Group comparison statistics were used to compare intercluster differences in demographics, homeless situation, symptoms, and subjective complaints. There were no major intercluster differences in socioethnic, demographic, and homeless situation variables. Differences occurred in complaints of depression, positive symptoms of psychosis, and suicidality. It was concluded that despite the disproportionate sizes of the clusters homeless veterans with mental illness are nevertheless heterogeneous with regard to their psychiatric profiles. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The long-term outcomes of mental health treatment in a population-based study.

This study examined the long-term outcomes of mental health treatment, specifically individual therapy, group therapy, and pharmacotherapy, in a population-based study. Using a prospective cohort design. the effectiveness of mental health treatment was analyzed on the basis of data from an epidemiological catchment area follow-up study, which assessed health care use and mental health status at 2 times, 15 years apart, in a random sample of Baltimore residents. A cohort of 771 men and women with at least 1 diagnosable Diagnostic and Statistical Manual of Mental Disorders disorder was selected from the 1,920 individuals randomly sampled in 1980 who were followed in 1994–1996. The results are consistent with clinical trials on the efficacy of pharmacotherapy and psychotherapy. After controlling for baseline psychopathology, sociodemographic characteristics, and service providers, participants who received group and individual therapy had lower distress at follow-up than those who either received medication or did not seek or receive any treatment. No concomitant reductions in the number of disorders were found, except for a dose–response association between the number of therapy sessions and the number of disorders at follow-up, as well as distress at follow-up. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gabapentin treatment of mood disorders: a preliminary study

OBJECTIVE: To determine if gabapentin is effective either as adjunctive treatment or as monotherapy for major affective disorders in a naturalistic setting. METHOD: All charts of patients meeting DSM-IV criteria for bipolar disorder or unipolar major depressive disorder treated with gabapentin in a private psychiatric practice were reviewed and clinical response was assessed retrospectively using the Clinical Global Impressions scale for Improvement (CGI-I). RESULTS: Gabapentin was moderately to markedly effective in 30% (15/50) of patients, with statistically nonsignificant differences between patients with bipolar disorder type I, bipolar disorder type II and NOS, and unipolar major depressive disorder. 70% reported side effects, mainly sedation, with 16% of the total sample discontinuing treatment due to adverse events. CONCLUSION: Gabapentin appears to be somewhat effective as add-on treatment in a subgroup of patients with mood disorders in a naturalistic setting. Prospective, controlled studies are required to clarify these pilot data.     

A preliminary study of clinical interventions in custody & access disputes.

Reviewed, retrospectively, 30 custody and access dispute cases (8 assessments, 22 arbitrations, and 10 mediations) and analyzed factors associated with each procedure. The factors examined were based on parents' views of their dispute, as recorded in an initial intake questionnaire completed preintervention. Findings suggest that couples who resolve their dispute through mediation tend to be more child-focused, future-oriented, positive about themselves, and helpful in providing suggestions for dispute resolution than parents involved in an assessment process. (French abstract) (6 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychiatric disorder and metabolic control among youths with IDDM. A longitudinal study

PURPOSE: To analyze the influence of liver dysfunction and parenchymal pathology on the accumulation of superparamagnetic iron oxide (SPIO). METHODS: We evaluated MR images of 13 patients having small hepatic neoplasms before and after administration of SPIO (10 micronol/kg). Biopsy and laboratory data confirmed the presence of severe cirrhosis in two patients, mild cirrhosis in four, chronic hepatitis in five, and normal livers in two. Degrees of liver dysfunction or liver parenchymal pathology were correlated with reductions in signal intensity of the liver and spleen after administration of SPIO. Signal intensity reduction was evaluated using a 1.5 Tesla MR unit. RESULTS: Response to SPIO of the liver and spleen did not correlate with liver parenchymal pathology, although reductions in signal intensity of the liver were somewhat small in severely cirrhotic livers. There were slight correlations between signal intensity alterations of the liver and laboratory data such as the indocyanine green retention rate (correlation coefficient 0. 47), albumin (0.36), total bilirubin (0.36), and serum glutamic oxaloacetic transaminase (GOT) (0.46). Signal intensity reduction of spleen did not correlate with liver function tests except for serum GOT. In patients with cirrhosis, heterogeneous structures were detected in the nontumorous portions of the liver. However, these did not prevent the diagnosis of small hepatomas. CONCLUSION: The uptake of SPIO showed some correlation with liver function but not with chronic liver parenchymal pathology. SPIO provided sufficient contrast between tumor and surrounding liver parenchyma among patients with chronic liver disease.     

Homeless youths and young adults in Los Angeles: prevalence of mental health problems and the relationship between mental health and substance abuse disorders

Although understanding of the subsistence patterns, service utilization, and HIV-risk behaviors of homeless youths and young adults in increasing, relatively little is known about the epidemiology of mental health problems in this group or the relationships between mental health problems and substance use. This study measured symptoms of depression, low self-esteem, ADHD, suicidality, self-injurious behavior (SIB), and drug and alcohol use disorder in a sample of homeless youth and young adults living in Hollywood, CA. Results indicated extremely high prevalences of mental health problems as compared with corresponding rates of mental health problems found among housed youths in previous studies. Prevalence of mental health problems differed by age and ethnicity. African Americans were at lower risk of suicidal thoughts and SIB than were those of other ethnicities. Older respondents and females were at increased risk of depressive symptoms, and younger respondents were at increased risk of SIB. Previous history of sexual abuse and/or assault was associated with increased risk of suicidality and SIB. Risk factors for drug abuse disorders included ethnicity other than African American, homelessness for 1 year or more, suicidality, SIB, depressive symptoms, and low self-esteem. Risk factors for alcohol abuse disorder included male gender, white ethnicity, homelessness for 1 year or more, suicidality, and SIB. Extremely high rates of mental health problems and substance abuse disorders in this sample suggest the need for street-based and nontraditional mental health services targeted toward these youths and young adults.     

Criterion validity of informants in the diagnosis of disruptive behavior disorders in children: A preliminary study.

The relative validity of the reports of parents, teachers, and children, and combinations of these informants was assessed using measures of concurrent impairment associated with disruptive behavior disorders as criterion variables in a clinic-referred sample of 177 boys ages 7–12 years. For oppositional defiant disorder (ODD) and conduct disorder (CD), the reports from teachers, alone and in combination with parents and children, showed the strongest relations to impairment criteria. The reports of parents and children, alone and in combination, were relatively less valid. For attention-deficit hyperactivity disorder, there were no significant correlations between the reports of any single informant or combination of informants and the impairment criteria. This study provides preliminary support for the validity of multi-informant diagnostic assessment of ODD and CD in children, especially when the teacher is one of the informants. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toward ICD-11: Improving the clinical utility of WHO's International Classification of mental disorders.

This article describes the current revision by the World Health Organization (WHO) of the International Classification of Diseases and Related Health Problems (ICD-10). ICD-10 is the basis for ICD-10-CM, which will be introduced in 2013 as the official U.S. system. U.S. psychologists will be required to use ICD-10-CM for all third-party billing and reporting, but are generally not familiar with the ICD or WHO's role in global health classification. Although the U.S. lags behind other countries on the implementation of WHO's international classification systems, psychologists and other health professionals will be affected by ICD-11, so it is important to understand its development. WHO views the current revision as an important opportunity to improve the clinical utility of the classification system for mental disorders. Serious problems with the clinical utility of both the ICD and the DSM are widely acknowledged. Clinical utility affects the daily lives of practitioners and is also a global public health issue. Most people with mental disorders worldwide receive no treatment. A diagnostic system with greater clinical utility can be a tool to improve identification and treatment, helping WHO member countries to reduce the disease burden of mental disorders. Consistent with this goal, WHO's revision process is global, multilingual, and multidisciplinary and will produce different versions of the classification for clinical use, research, and primary care. A systematic program of studies being undertaken by WHO aimed at improving clinical utility is described. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coercion and empowerment in the treatment of individuals with serious mental illness: A preliminary investigation.

Recently, treatment approaches for individuals with serious mental illness (SMI) have sought to increase autonomy to prevent frequent hospitalizations. Two of these strategies are coercive treatment and empowerment. Both coercive treatment and empowerment attempt to increase an individual's freedom from illness as well as rehospitalization. In the literature coercion is viewed as a barrier to empowerment, yet the long-term goals of both approaches are similar. Thus, coercive treatment may not serve as a barrier to empowerment. This study is a preliminary investigation of the empirical relationship between and among coercion, functioning, and empowerment. Participants were recruited from treatment centers in Mississippi and were at varying stages of treatment including inpatient and outpatient (N = 64). Variables of interest were measured with the MacArthur Admissions Experience Survey, Brief Symptom Inventory, Multnomah Community Ability Scale, MacArthur Competence Assessment Tool-Treatment, and Empowerment Scale. In this sample, only functioning was predictive of empowerment, suggesting that empowerment is dependent on an individual's level of functioning. In addition, coercion may not necessarily disempower individuals with SMI. Implications and directions for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A clinical study of substance dependence patients combined with other psychiatric disorders

The present study was conducted for clarifying the comorbidity of substance dependence and other psychiatric disorders in outpatients of four psychiatric hospitals in May, 1995. The results were as follows; 7.4% (N = 234) of the total 3155 psychiatric outpatients were diagnosed as substance dependence. Among those substance dependence patients, alcohol dependence accounted for 82.5% and the percentage of the other substance dependence were very small, i.e., methamphetamine dependence 6.4%, solvent dependence 1.7%, multiple substance dependence 9.4%, respectively. The percentage of comorbidity of substance dependence and psychiatric disorders was 23.9% (N = 56) of 234 substance dependence patients. The percentage of co-morbid alcohol dependence patients with affective disorder in all affective disorder patients was 5.0%; the percentage of comorbidity of alcohol dependence in neurotic patients 4.1%; the percentage of alcohol dependence comorbidity in schizophrenic patients 0.7%. In many cases, onsets of substance dependence and psychiatric disorders were within 2 years, which suggests the common backgrounds for substance dependence and psychiatric disorders, such as disruption of family and occupational life, stress and individual vulnerability, and substance use for self-medication. The study indicates that the percentages of diagnosed comorbidity of substance dependence and psychiatric disorders are generally smaller in Japan than in the U.S., which may be based on the differences of diagnostic standards between the two countries. Further studies are needed on the comorbidity of substance dependence and psychiatric disorders in other general hospital and psychiatric clinic patients.     

Reducing risks of mental disorders.

Presents views on the prevention of mental disorders, with a focus on the reports entitled Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research (P. J. Mrazek and R. J. Haggerty, 1994) and The Prevention of Mental Disorders: A National Research Agenda (NIMH Prevention Research Steering Committee, 1994), prepared by the Institute of Medicine (IOM) and the National Institute of Mental Health, respectively. Congress must work closely with NIMH to ensure that recommendations made by the IOM to advance the field of prevention of mental disorders are implemented. Also, the mental health community will need to be proactive with Congress to make a difference in critical decisions about financing for the treatment and prevention of mental disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Issues in the transportability of treatment: The case of anxiety disorders in youths.

This article reviews factors working against or in favor of the transportability of manual-based child treatments from research clinics to service practitioners. The review examines client factors, service clinic therapist factors, and researcher factors that may contribute to the reported gap between research and practice outcomes. As requested for this special section, this article uses work with anxiety-disordered youths as an example of a potentially transportable manual-based treatment. Issues and future directions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexual behavior in young adulthood: A population-based twin study.

Objective: With behavior genetic analyses of data from young adult twins, we evaluated theoretical perspectives that differentially emphasize biological dispositions, social/cultural factors, or universal pathways to explain individual differences in sexual behaviors. Design: We fit biometric sex limitation models to three aspects of sexual behavior reported by 4,925 Finnish twins ages 23-27. Main Outcome Measure: From a postal questionnaire, we obtained self-report information on initiation/abstinence of sexual intercourse, onset age, and number of sexual partners. Results: Genetic and non-shared environmental influences were significant for all three measures. There were trends for common environmental influences on initiation and, in females, age at first intercourse. Some differential effects in males and females were found. Results comparing onset age and number of partners among experienced twins from pairs concordant and discordant for initiation found genetic and environmental influences on initiation/abstinence overlapped those found for the other aspects of sexual behavior. Conclusions: These results document genetic variation in individual differences in sexual behavior of young adults. Incorporating genetic dispositions into integrated models of sexual behavior will facilitate more effective health promotion and risk taking intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)