Discriminative validity of parent report of hypomanic and depressive symptoms on the General Behavior Inventory.

It often is difficult clinically to differentiate bipolar disorder from other mental health conditions in young people. This study evaluated a parent report measure of depressive and hypomanic/biphasic symptoms. Parents of 196 youths, who were 5 to 17 years old and presented at an outpatient research center, completed an adapted General Behavior Inventory (GBI). Factor analyses suggested two dimensions, depression and biphasic/hypornania. Logistic regressions using these scales discriminated mood disorder versus disruptive behavior disorder or no diagnosis, unipolar versus bipolar disorder, and bipolar versus disruptive behavior disorder based on structured interviews. Classification rates exceeded 80%, and receiver operating characteristic analyses showed good diagnostic efficiency for the scales, with areas under the curve greater than .80. Results indicate that clinicians can use the parent-completed GBI to derive clinically meaningful information about mood disorders in youths. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Current treatments for bipolar disorder: A review and update for psychologists.

Practicing psychologists are likely to be confronted with the diagnostic and treatment challenges associated with bipolar disorder, particularly the various classes of medication currently used in pharmacotherapy for the disorder. Although lithium remains a valuable resource, limitations associated with its use have prompted clinicians and researchers to explore the application of several different classes of agents, including anticonvulsants, calcium channel blockers, atypical antipsychotics, benzodiazepines and antidepressants, to the acute and long-term management of bipolar disorder. A review of these agents, as well as a summary of various psychotherapeutic modalities that can serve as adjunctive interventions to pharmacotherapy, is provided for psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A behavioral paradigm for identifying persons at risk for bipolar depressive disorder: A conceptual framework and five validation studies.

Attempted to study predisposition to bipolar manic-depressive disorder by developing a behavioral paradigm to identify persons at risk for various forms of the disorder. A theoretical discussion is given for defining bipolar disorder within the broader framework of common human diseases, and this framework is used to derive dimensions of bipolar disorder that define its distinctness from the normal phenotype. These dimensions (behavioral and nonbehavioral features of disorder) are operationalized in the form of a self-report inventory that estimates the probability that an individual is at risk. Five external validation studies using nontest criteria are presented, including interview, roommate, family history, clinical characteristics, and longitudinal mood rating investigations. Results indicate that the inventory serves as a promising 1st-stage case identification procedure for bipolar disorder when employed in a research context. (2? p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Selecting a short form of the MMPI: Addendum to Faschingbauer.

T. R. Faschingbauer (1976) offered guidelines to clinicians in the selection of MMPI short forms as substitutes for the full MMPI. This comment offers an addendum to Faschingbauer in the form of a review of empirical studies of the clinical validity of MMPI short forms and a discussion of the MMPI-168, which was not considered in Faschingbauer's earlier article. For diagnostic and interpretive accuracy, the empirical evidence to date seems to favor 2 short forms—the Faschingbauer Abbreviated MMPI and the MMPI-168—over the other available short forms. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Use of Dialectical Behavior Therapy Strategies in the Psychiatric Emergency Room.

The goal of the present article is to show how specific dialectical behavior therapy (DBT) strategies and techniques can supplement traditional psychiatric emergency room (ER) practice by potentially increasing outpatient treatment compliance in parasuicidal patients with borderline personality disorder traits. Unlike the traditional psychiatric approach, DBT provides emotionally dysregulated patients with a framework for understanding their chaotic interpersonal lives. The authors stress the importance of implementing paradoxical interventions, which aim at unbalancing the patient and increasing readiness for change, in the context of validation, which aims at acceptance and restores the communicative function of emotions. The authors illustrate--through case examples drawn from a large, metropolitan hospital--how emergency room clinicians using DBT strategies can enhance readiness for change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of a clinician's sexual abuse history, gender, and theoretical orientation on treatment issues related to childhood sexual abuse.

This study examined the impact of childhood sexual abuse history (CSA), gender, and theoretical orientation on treatment issues related to childhood sexual abuse. A survey of 501 clinicians found that 32% reported CSA histories. Sexually abused therapists were more likely to report some countertransference issues, especially boundary issues, than nonabused therapists, but gender differences were more important in determining differences in clinical practice. Female clinicians reported that CSA was more difficult to treat, that they screened more regularly for CSA, and that they utilized more coping strategies than male clinicians. Dissimilarities were also found between self-identified feminist therapists and psychoanalysts in their clinical practices, including the use of personality disorder diagnoses, reported countertransference issues, and coping strategies. Greater recognition of these issues in training programs is recommended. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Guidelines for differential diagnoses in a population with posttraumatic stress disorder.

In a large posttraumatic stress disorder (PTSD) and depression treatment outcome study, thorough diagnostic assessments of veterans at pretreatment, posttreatment, and 3 follow-up times were completed. The research team that reviewed these assessments encountered several challenges in the differential diagnosis of PTSD because of high comorbidity and symptoms shared with or resembling other disorders. For example, how do mental health professionals distinguish symptoms of agoraphobia from avoidance and hypervigilance symptoms of PTSD? When are hallucinations symptomatic of PTSD (e.g., flashbacks) versus a nonpsychotic near-death experience or an independent psychotic disorder? How do mental health professionals differentiate overlapping symptoms of PTSD and depressive disorders? To help make reliable diagnoses, the team developed clarifying questions and diagnostic guidelines, which may prove useful to other clinicians and researchers working with PTSD populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of the SADS—C as a diagnostic and symptom severity measure.

Examined the reliability of an abbreviated form of the full Schedule for Affective Disorders and Schizophrenia (SADS), the SADS—C, in 2 studies. A total of 120 nonparanoid and paranoid schizophrenic, bipolar manic, and unipolar depressed patients and 26 normal Ss (mean age for all groups 31.8 yrs) were interviewed using the SADS—C and a number of other diagnostic instruments. Results of both studies suggest that the SADS—C is a reliable brief rating instrument capable of differentiating among psychopathological groups. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Obsessional personality traits and risk for bipolar affective disorder: An offspring study.

Explored the potential utility of obsessionality as a differential risk index among relatives of bipolar patients by examining the relation between obsessional traits and cyclothymia, a precursor form of bipolar illness, in 41 15–21 yr old offspring of parents with bipolar affective disorder. Ss completed 2 measures of obsessional personality traits and were administered a general behavior inventory (a case identification inventory for cyclothymia) and a structured diagnostic interview. Cyclothymic offspring obtained significantly higher scores than did noncyclothymes on the superego-strength measure of obsessional traits. Moreover, obsessionality was significantly correlated with affective symptom ratings but was not related to nonaffective behavior disturbances. Although a long-term follow-up is necessary to confirm these findings, these data suggest that obsessional traits may be associated with risk for bipolar disorder in the offspring of bipolar probands. (61 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical psychologists' theory-based representations of mental disorders predict their diagnostic reasoning and memory.

The theory-based model of categorization posits that concepts are represented as theories, not feature lists. Thus, it is interesting that the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV, American Psychiatric Association, 1994) established atheoretical guidelines for mental disorder diagnosis. Five experiments investigated how clinicians handled an atheoretical nosology. Clinicians' causal theories of disorders and their responses on diagnostic and memory tasks were measured. Participants were more likely to diagnose a hypothetical patient with a disorder if that patient had causally central rather than causally peripheral symptoms according to their theory of the disorder. Their memory for causally central symptoms was also biased. Clinicians are cognitively driven to use theories despite decades of practice with the atheoretical DSM. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diagnostic labeling in juvenile justice settings: Do psychopathy and conduct disorder findings influence clinicians?

Do provocative diagnostic labels such as psychopathy or conduct disorder influence clinicians who work in juvenile justice settings? Juvenile justice clinicians (N = 109) responded to a mock psychological evaluation of a juvenile, which varied antisocial history, psychopathic personality features, and diagnosis (psychopathy, conduct disorder, or none). Psychopathic personality features and antisocial behavioral history led to higher clinician ratings of the juvenile's risk for future criminality. A psychopathy label also led to higher clinician ratings of risk, but only when there was a minimal history of antisocial behavior. No diagnostic labels influenced clinician ratings regarding treatment. Viewed alongside other research on labeling in the juvenile justice system, clinicians appear to be somewhat more responsive to mention of the psychopathy construct than are nonclinical juvenile justice professionals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development and validation of a scale for hypomanic personality.

Constructed a hypomanic personality scale (HPS) to identify persons with hypomanic personality, an overactive, gregarious style associated with episodes of hypomanic euphoria and expected in some persons at risk for bipolar disorder. 1,519 undergraduates were tested with the HPS in a concurrent validity study. 40 experimental Ss with scores at least 1.67 standard deviations above the mean for their sex were compared to 40 control Ss, using modified versions of the Schedule for Affective Disorders and Schizophrenia—Lifetime Version (SADS-L) and the Social Adjustment Scale. Results indicate that experimental Ss exceeded control Ss on measures of hypomanic personality characteristics, depressive symptoms, alcohol and drug use, and schizotypal and psychoticlike symptoms. 31 experimental Ss but no control Ss experienced SADS-L hypomanic episodes. Results appear to justify the follow-up of such persons to evaluate risk for bipolar disorder. (37 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cyclothymia in the adolescent offspring of parents with bipolar affective disorder.

Explored the prevalence and types of psychopathology exhibited by the adolescent and young adult offspring (n?=?37, aged 15–21 yrs) of 24 patients (mean age 48.4 yrs) with bipolar affective disorder and by the age-matched offspring (n?=?22) of 14 patients (mean age 46.7 yrs) with nonaffective psychiatric disorders. It was hypothesized that the offspring of bipolar Ss would be characterized by an increased rate of cyclothymia. Offspring received structured diagnostic interviews conducted by interviewers unaware of parental diagnosis. Anonymous diagnoses were derived based on Research Diagnostic Criteria. It was found that the offspring of bipolar Ss exhibited significantly higher rates of affective disorder in general and cyclothymia in particular than the offspring of the nonaffective controls, a finding concordant with the proposed hypothesis. The offspring groups did not differ on rates of nonaffective disorders. Results support a continuum model of bipolar disorder in which cyclothymia is viewed as a mild form of full syndromal bipolar illness. (84 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rethinking the mood and anxiety disorders: A quantitative hierarchical model for DSM-V.

The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994) groups disorders into diagnostic classes on the basis of the subjective criterion of "shared phenomenological features." There are now sufficient data to eliminate this rational system and replace it with an empirically based structure that reflects the actual similarities among disorders. The existing structural evidence establishes that the mood and anxiety disorders should be collapsed together into an overarching class of emotional disorders, which can be decomposed into 3 subclasses: the bipolar disorders (bipolar I, bipolar II, cyclothymia), the distress disorders (major depression, dysthymic disorder, generalized anxiety disorder, posttraumatic stress disorder), and the fear disorders (panic disorder, agoraphobia, social phobia, specific phobia). The optimal placement of other syndromes (e.g., obsessive-compulsive disorder) needs to be clarified in future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effective treatment relationships for persons with serious psychiatric disorders: The importance of attachment states of mind.

Participants were 54 clients with serious psychiatric disorders and 21 clinical case managers. Clients' serious psychiatric disorders included Axis I diagnoses, such as schizophrenia and bipolar disorder. This study examined how attachment states of mind of both clients and case managers influenced the effectiveness of therapeutic relationships and client functioning. Client and case manager attachment states of mind interacted in predicting the working alliance and client functioning. Specifically, clients who were more deactivating with respect to attachment had better alliances and functioned better with less deactivating case managers, whereas clients who were less deactivating worked better with more deactivating case managers. These findings highlight the importance of clinicians and clients being matched in ways that balance their interpersonal and emotional strategies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Vicarious traumatization, spirituality, and the treatment of sexual abuse survivors: A national survey of women psychotherapists.

Should psychotherapists limit their clinical work with trauma survivors to avoid being traumatized themselves? Vicarious traumatization (VT—the symptoms similar to posttraumatic stress disorder and the disruption in cognitive schemas reported in clinicians who are exposed to the trauma material of their clients—was assessed in a national survey of 1,000 women psychotherapists. Therapists with higher levels of exposure to sexual abuse material reported significantly more trauma symptoms but no significant disruption of cognitive schemas. Spiritual well-being, a key area thought to be damaged by VT, was found to be higher for those clinicians who saw more sexual abuse survivors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Soluble recombinant neutral endopeptidase (CD10) as a potential antiinflammatory agent

The present study assessed fidelity to the behavioral family management (BFM) model for treating bipolar disorder patients and their families. The BFM Therapist Competency/Adherence Scale (BFM-TCAS) was developed to evaluate clinicians' competency and adherence to BFM, as outlined by Miklowitz' (1989) BFM Manual for use with bipolar patients. Therapist competency and treatment adherence was also evaluated with regard to two family characteristics: overall level of family difficulty and family expressed emotion (EE) status. The BFM-TCAS was used to code 78 videotaped sessions of 26 families with a bipolar member, selected from a larger treatment study of bipolar disorder patients. The findings suggest that, overall, clinicians adhered closely to the BFM manual. Specific areas in which there was high competency and treatment adherence were (a) skill in conveying factual information about bipolar illness, (b) establishment of a therapeutic environment, and (c) ability to take command of therapy sessions. The one area in which there was less competency and relatively weak adherence to the manual was the use of between-session homework assignments to assist families in mastering the BFM exercises. Results of this study also suggest that, for the most part, therapist competency and adherence ratings were not related to overall level of difficulty or to family EE status.     

Systematic clinical methodology for validating bipolar-II disorder: data in mid-stream from a French national multi-site study (EPIDEP)

BACKGROUND: This paper presents the methodology and clinical data in mid-stream from a French multi-center study (EPIDEP) in progress on a national sample of patients with DSM-IV major depressive episode (MDE). The aim of EPIDEP is to show the feasibility of validating the spectrum of soft bipolar disorders by practising clinicians. In this report, we focus on bipolar II (BP-II). METHOD: EPIDEP involves training 48 French psychiatrists in 15 sites; construction of a common protocol based on the criteria of DSM-IV and Akiskal (Soft Bipolarity), as well as criteria modified from the work of Angst (Hypomania Checklist), the Ahearn-Carroll Bipolarity Scale, HAM-D and Rosenthal Atypical Depression Scale; Semi-Structured Interview for Evaluation of Affective Temperaments (based on Akiskal-Mallya), self-rated Cyclothymia Scale (Akiskal), family history (Research Diagnostic Criteria); and prospective follow-up. RESULTS: Results are presented on 250 (of the 537) MDE patients studied thus far during the acute phase. The rate of BP-II disorder which was 22% at initial evaluation, nearly doubled (40%) by systematic evaluation. As expected from the selection of MDE by uniform criteria, inter-group comparison between BP-II vs unipolar showed no differences on the majority of socio-demographic parameters, clinical presentation and global intensity of depression. Despite such uniformity, key characteristics significantly differentiated BP-II from unipolar: younger age at onset of first depression, higher frequency of suicidal thoughts and hypersomnia during index episode, higher scores on Hypomania Checklist and cyclothymic and irritable temperaments, and higher switching rate under current treatment. Eighty-eight percent of cases assigned to cyclothymic temperament by clinicians (with a cut-off of 10/21 items on self-rated cyclothymia) were recognized as BP-II. Evaluation of this temperament by clinician and patient correlated at a highly significant level (r=0.73; p <0.0001). Cyclothymia and hypomania were also correlated significantly (r=0.51; p < 0.001). LIMITATION: In a study conducted in diverse clinical settings, it was not possible to assure that clinicians making affective diagnoses were blind to the various temperamental measures. However, bias was minimized by the systematic and/or semi-structured nature of all evaluations. CONCLUSION: With a systematic search for hypomania, 40% of major depressive episodes were classified as BP-II, of which only half were known to the clinicians at study entry. Cyclothymic temperamental dysregulation emerged as a robust clinical marker of BP-II disorder. These data indicate that clinicians in diverse practice settings can be trained to recognize soft bipolarity, leading to changes in diagnostic practice at a national level.     

Bridging the gap between laboratory and clinic in child and adolescent psychotherapy.

Meta-analyses of laboratory outcome studies reveal beneficial effects of psychotherapy with children and adolescents. However, the research therapy in most of those lab studies differs from everyday clinic therapy in several ways, and the 9 studies of clinic therapy the authors have found show markedly poorer outcomes than research therapy studies. These findings suggest a need to bridge the long-standing gap between outcome researchers and clinicians. Three kinds of bridging research are proposed and illustrated: (a) enriching the research data base on treatment effects by practitioners in clinical settings—including private practice and health maintenance organizations, (b) identifying features of research therapy that account for positive outcomes and applying those features to clinical practice, and (c) exporting lab-tested treatments to clinics and assessing their effects with referred youths. If these bridging strategies were widely adopted, despite the numerous obstacles described herein, real progress might be made toward more effective treatment in clinical practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Beyond clinical trials: Generalizing from research to practice.

Suggests that clinical trials, or evaluations of psychotherapy techniques in clinical settings with patient populations, play a pivotal role in treatment research. Well-controlled psychotherapy trials provide a test of what treatment can do under conditions in which procedures such as therapist training and monitoring and the integrity of treatment are optimal. Methods designed to reduce the hiatus in how treatments are implemented, monitored, and evaluated in clinical research and practice include developing standardized assessment and treatment packages that can be implemented by practitioners, altering the manner in which clinical training is implemented and evaluated, training clinicians in strategies to evaluate their own clinical work, and conducting clinical replication case studies as a way to evaluate treatment applications in clinical practice. These alternatives combine standardization, training, evaluation, and clinical practice to help increase the generality of research findings to clinical work and to help merge research and clinical priorities. (46 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)