Factors influencing service utilization and mood symptom severity in children with mood disorders: Effects of multifamily psychoeducation groups (MFPGs).

This study investigated the impact of psychoeducation on service utilization and mood symptom severity in children with mood disorders. Parents’ knowledge of mood disorders, beliefs about treatment, and perceptions of children’s need for treatment were hypothesized to mediate the relationship between psychoeducation and service utilization and between psychoeducation and mood symptom severity. Linear mixed effects modeling and joint significance test for mediation were used in secondary data analyses of the multifamily psychoeducation group (MFPG) study, a randomized controlled trial of 165 children ages 8 to 12 years with mood disorders. A majority of those sampled were male (73%) and White, non-Hispanic (90%), and the median range of family income was $40,000–$59,000. Participation in MFPG significantly improved quality of services utilized, mediated by parents’ beliefs about treatment. Participation in MFPG also significantly improved severity of child’s mood symptoms, mediated by quality of services utilized. MFPG appears to be a psychoeducational intervention that helps parents to become better consumers of the mental health system who access higher quality services. Children’s symptom severity decreases as a result. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ecological momentary assessment of mood disorders and mood dysregulation.

In this review, we discuss ecological momentary assessment (EMA) studies on mood disorders and mood dysregulation, illustrating 6 major benefits of the EMA approach to clinical assessment: (a) Real-time assessments increase accuracy and minimize retrospective bias; (b) repeated assessments can reveal dynamic processes; (c) multimodal assessments can integrate psychological, physiological, and behavioral data; (d) setting- or context-specific relationships of symptoms or behaviors can be identified; (e) interactive feedback can be provided in real time; and (f) assessments in real-life situations enhance generalizability. In the context of mood disorders and mood dysregulation, we demonstrate that EMA can address specific research questions better than laboratory or questionnaire studies. However, before clinicians and researchers can fully realize these benefits, sets of standardized e-diary questionnaires and time sampling protocols must be developed that are reliable, valid, and sensitive to change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family functioning and mood disorders: A comparison between patients with major depressive disorder and bipolar I disorder.

Within a sample of patients with major depressive disorder (MDD; n = 121) and bipolar affective disorder (BPAD; n = 69), the authors examined (a) diagnostic differences in family functioning at acute episode, (b) diagnostic differences in family functioning at episode recovery, (c) within-group changes in family functioning from acute episode to recovery, and (d) whether within-group changes from acute episode to recovery varied by diagnosis. Using a multidimensional model, the authors evaluated interviewer, patient, and family ratings. Overall, patients with MDD and BPAD evidenced similar levels of family impairment at acute episode and recovery. Generally, patients in both groups experienced improvement in family functioning over time, yet mean scores at recovery continued to range from fair to poor. Although certain specific differences emerged, diagnostic groups appeared to be more similar than different in level and pattern of family functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reliability of DSM-IV anxiety and mood disorders: Implications for the classification of emotional disorders.

The reliability of current and lifetime Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994) anxiety and mood disorders was examined in 362 outpatients who underwent 2 independent administrations of the Anxiety Disorders Interview Schedule for DSM-IV: Lifetime version (ADIS-IV–L). Good to excellent reliability was obtained for the majority of DSM-IV categories. For many disorders, a common source of unreliability was disagreements on whether constituent symptoms were sufficient in number, severity, or duration to meet DSM-IV diagnostic criteria. These analyses also highlighted potential boundary problems for some disorders (e.g., generalized anxiety disorder and major depressive disorder). Analyses of ADIS-IV–L clinical ratings (0–8 scales) indicated favorable interrater agreement for the dimensional features of DSM-IV anxiety and mood disorders. The findings are discussed in regard to their implications for the classification of emotional disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample.

The comorbidity of current and lifetime DSM-IV anxiety and mood disorders was examined in 1,127 outpatients who were assessed with the Anxiety Disorders Interview Schedule for DSM-IV:Lifetime version (ADIS-IV-L). The current and lifetime prevalence of additional Axis I disorders in principal anxiety and mood disorders was found to be 57% and 81%, respectively. The principal diagnostic categories associated with the highest comorbidity rates were mood disorders, posttraumatic stress disorder (PTSD), and generalized anxiety disorder (GAD). A high rate of lifetime comorbidity was found between the anxiety and mood disorders; the lifetime association with mood disorders was particularly strong for PTSD, GAD, obsessive-compulsive disorder, and social phobia. The findings are discussed in regard to their implications for the classification of emotional disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Treatment Beliefs Questionnaire (TBQ): An instrument to assess beliefs about children's mood disorders and concomitant treatment needs.

Parent and child beliefs about the child's mood disorder and need for treatment may affect the willingness of the patient and his or her family to participate in and adhere to treatment recommendations. Such beliefs may also affect mental health treatment outcomes. However, there is a paucity of research in this area, which is further reflected in a lack of assessment instruments. The present study describes the creation and initial psychometric evaluation of parent and child versions of the Treatment Beliefs Questionnaire (TBQ) in a sample of 8- to 11-year-old children with a primary mood disorder and comorbid psychiatric conditions. Preliminary results support the reliability and validity of these scales in this population. The role of health beliefs in mental health treatment adherence and treatment outcome is addressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-based assessment of childhood mood disorders: Reply to Lee and Hunsley (2003).

Responds to a comment by C. M. Lee and J. Hunsley (see record 2003-04125-017) on the present authors' original article on advances in the diagnosis and treatment of childhood mood disorders (see record 2002-12134-002). In their comment, Lee and Hunsley took issue with a statement by the present authors advocating the use of projective tests, which are less empirically well-validated than other assessment techniques. The current authors concur with Lee and Hunsley that evidence-based techniques (where they exist) should be employed within a multidimensional, multi-informant, developmentally sensitive context. However, they also maintain that an optimal set of tools for identifying and treating childhood mood disorders has yet to be conclusively identified and that the clinician may ultimately find useful a broad array of techniques that are currently less well-validated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

On the hierarchical structure of mood and anxiety disorders: Confirmatory evidence and elaboration of a model of temperament markers.

The authors examined D. Watson's (2005) proposed reconceptualization of the diagnostic categories for mood and anxiety disorders for the Diagnostic and Statistical Manual of Mental Disorders--Fifth Edition (DSM-V) and tested an elaboration of the 2-factor (positive and negative activation) model of underlying temperament markers that incorporates A. Tellegen, D. Watson, & L. A. Clark's (1999a, 1999b) higher-order dimension of happiness-unhappiness (or demoralization; see A. Tellegen et al., 2003). In Study 1, 502 undergraduate students completed several symptom measures of mood and anxiety disorders and the Minnesota Multiphasic Personality Inventory-2 (J. N. Butcher et al., 2001). Using confirmatory factor analysis, the authors replicated Watson's distress and fear disorder model. Path analyses showed that demoralization was a primary marker of distress disorders, whereas dysfunctional negative emotions was a primary marker of fear disorders. Low positive emotions was a specific marker of depression and social phobia. This 3-factor path model was associated with better fit than was a 2-factor model excluding demoralization. In Study 2, the authors replicated the findings of Study 1 using data from an archival clinical sample of 636 Veterans Affairs hospital outpatients. The authors' findings provide evidence on the important role of demoralization in mood and anxiety disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Affective instability, family history of mood disorders, and neurodevelopmental disturbance.

The association between affective instability and both family history of mood disorders and signs of neurodevelopmental disturbance was examined in a sample of 303 adults. Affective instability was measured using the borderline personality disorder “affective instability due to a marked reactivity of mood” diagnostic criterion as assessed dimensionally using the Personality Disorder Interview—IV. Participants were interviewed concerning family history of mood disorders, with family history coded using the Family History Research Diagnostic Criteria. Minor physical anomalies, inconsistent hand use, and dermatoglyphic asymmetries were used to index neurodevelopmental disturbance. Affective instability was associated with elevated rates of family history of mood disorders, particularly among individuals who exhibited inconsistent hand use and greater minor physical anomalies. These associations could not be accounted for by shared variance with age, gender, negative affect, or personal history of mood disorders. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Psychiatric disorders in smokers seeking treatment for tobacco dependence: Relations with tobacco dependence and cessation.

Objective: The present research examined the relation of psychiatric disorders to tobacco dependence and cessation outcomes. Method: Data were collected from 1,504 smokers (58.2% women; 83.9% White; mean age = 44.67 years, SD = 11.08) making an aided smoking cessation attempt as part of a clinical trial. Psychiatric diagnoses were determined with the Composite International Diagnostic Interview structured clinical interview. Tobacco dependence was assessed with the Fagerstr?m Test of Nicotine Dependence (FTND) and the Wisconsin Inventory of Smoking Dependence Motives (WISDM). Results: Diagnostic groups included those who were never diagnosed, those who had ever been diagnosed (at any time, including in the past year), and those with past-year diagnoses (with or without prior diagnosis). Some diagnostic groups had lower follow-up abstinence rates than did the never diagnosed group (ps OR = .72, p = .02) and those ever diagnosed with more than one psychiatric diagnosis (OR = .74, p = .03) had lower abstinence rates. The diagnostic categories did not differ in smoking heaviness or the FTND, but they did differ in dependence motives assessed with the WISDM. Conclusion: Information on recent or lifetime psychiatric disorders may help clinicians gauge relapse risk and may suggest dependence motives that are particularly relevant to affected patients. These findings also illustrate the importance of using multidimensional tobacco dependence assessments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Combined treatment for children with learning disorders.

The causes of learning disorders are numerous and, although some learning difficulties can be remedied by special educative measures only, many such problems, especially when they are more severe represent a disorder of the total personality. In such a case a diagnosis must be established by a team of different specialists. After a careful evaluation a treatment programme is planned and a choice is made among various specific therapies. Very often the treatment of learning disorders must take into account more or less important emotional factors. A combined approach of psychotherapy and remedial teaching is sometimes essential to attain some success in helping a child. Such a combination of treatments requires close cooperation between psychotherapist and special teacher. Their respective roles have to be frequently clarified and both gain in understanding of the child needs through mutual communication. Following the evolution of a child from two points of view demonstrates more and more clearly how the intellectual processes necessary for learning are subject to inhibiting patterns that are observed in neurotic defense mechanisms against emotional conflicts. In some instances this practical knowledge would be necessary to understand why a child does not profit from remedial measures and to determine how new techniques are to be used to help him. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-based assessment of childhood mood disorders: Comment on McClure, Kubiszyn and Kaslow (2002).

Comments on an article by E. B. McClure et al (see record 2002-12134-002), which reviewed advances in the diagnosis and treatment of childhood mood disorders and exhorted practitioners to disseminate evidence-based information to families. The present authors argue that there is a clear contradiction between McClure et al's call for the use of evidence-based measures and their advocacy of projective methods. It is argued that the projective techniques proposed by McClure et al as being clinically valuable all have substantial shortcomings with respect to psychometric criteria of standardization, norms, reliability, and validity. To illustrate the problems with these methods, the authors briefly present some of the problems known to exist with projective drawings and the Rorschach. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Negative mood, depressive symptoms, and major depression after smoking cessation treatment in smokers with a history of major depressive disorder.

Negative mood, depressive symptoms, and major depressive episodes (MDEs) were examined in 179 smokers with a history of major depression in a trial comparing standard smoking cessation treatment to treatment incorporating cognitive-behavioral therapy for depression (CBT-D). Early lapses were associated with relatively large increases in negative mood on quit date. Mood improved in the 2 weeks after quit date among those returning to regular smoking but not among those smoking moderately. Continuous abstinence was associated with short- and long-term reductions in depressive symptoms. MDE incidence during follow-up was 15.3% and was not associated with abstinence. Unexpected was that CBT-D was associated with greater negative mood and depressive symptoms and increased MDE risk. Results suggest complex bidirectional associations between affect and smoking outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A proposal for a dimensional classification system based on the shared features of the DSM-IV anxiety and mood disorders: Implications for assessment and treatment.

A wealth of evidence attests to the extensive current and lifetime diagnostic comorbidity of the Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM–IV) anxiety and mood disorders. Research has shown that the considerable cross-sectional covariation of DSM–IV emotional disorders is accounted for by common higher order dimensions such as neuroticism/behavioral inhibition (N/BI) and low positive affect/behavioral activation. Longitudinal studies indicate that the temporal covariation of these disorders can be explained by changes in N/BI and, in some cases, initial levels of N/BI are predictive of the temporal course of emotional disorders. The marked phenotypal overlap of the DSM–IV anxiety and mood disorders is a frequent source of diagnostic unreliability (e.g., temporal overlap in the shared features of generalized anxiety disorder and mood disorders, situation specificity of panic attacks in panic disorder and specific phobia). Although extant dimensional proposals may address some drawbacks associated with the DSM nosology (e.g., inadequate assessment of individual differences in disorder severity), these proposals do not reconcile key problems in current classification, such as modest reliability and high comorbidity. This article considers an alternative approach that emphasizes empirically supported common dimensions of emotional disorders over disorder-specific criteria sets. Selection and assessment of these dimensions are discussed along with how these methods could be implemented to promote more reliable and valid diagnosis, prognosis, and treatment planning. For instance, the advantages of this system are discussed in context of transdiagnostic treatment protocols that are efficaciously applied to a variety of disorders by targeting their shared features. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

For suicidal young adults with comorbid depressive and anxiety disorders, probem-solving treatment may be better than treatment as usual.

Practicing psychologists face many complexities and challenges in caring for suicidal patients who have comorbid mood and anxiety disorders. Not only must suicidal crises be addressed, but co-occurring depressive and anxiety symptoms compete for attention as well and are associated with relatively poor clinical prognosis in usual treatments. The current study compared problem-solving treatment to treatment as usual among depression–anxiety comorbid versus noncomorbid clinically suicidal young adults. Suicidal patients with mood and anxiety disorders were randomized to the 2 treatments and followed over time. Comorbid suicidal patients, in particular, experienced notable symptom improvements from the problem-solving treatment. Features of the problem-solving treatment are described for use in clinical practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Molecular modulation of prefrontal cortex: Rational development of treatments for psychiatric disorders.

Dysfunction of the prefrontal cortex (PFC) is a central feature of many psychiatric disorders, such as attention deficit hyperactivity disorder (ADHD), posttraumatic stress disorder (PTSD), schizophrenia, and bipolar disorder. Thus, understanding molecular influences on PFC function through basic research in animals is essential to rational drug development. In this review, we discuss the molecular signaling events initiated by norepinephrine and dopamine that strengthen working memory function mediated by the dorsolateral PFC under optimal conditions, and weaken working memory function during uncontrollable stress. We also discuss how these intracellular mechanisms can be compromised in psychiatric disorders, and how novel treatments based on these findings may restore a molecular environment conducive to PFC regulation of behavior, thought and emotion. Examples of successful translation from animals to humans include guanfacine for the treatment of ADHD and related PFC disorders, and prazosin for the treatment of PTSD. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Sudden gains in prolonged exposure for children and adolescents with posttraumatic stress disorder.

Objective: Our objective was to examine sudden gains during developmentally adjusted prolonged exposure for posttraumatic stress disorder (PTSD) among children and adolescents. We hypothesized that sudden gains would be detected and would be predictive of treatment outcome and follow-up. Method: Sixty-three youngsters (ages 8–17) completed a developmentally adjusted protocol for the treatment of pediatric PTSD (Foa, Chrestman, & Gilboa-Schechtman, 2008). Participants' posttraumatic and depressive symptoms were assessed before each treatment session, as well as at approximately 3 and 12 months after treatment termination. We measured posttraumatic symptoms with the Child PTSD Symptom Scale (Foa, Johnson, Feeny, & Treadwell, 2001) and measured depressive symptoms with the Beck Depression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961) and the Children's Depression Inventory (Kovacs, 1981, 1982). Results: Sudden gains were found among 49.2% of participants and constituted 48.6% of the total reduction in posttraumatic symptoms. Compared to individuals who did not experience sudden gains, individuals who experienced sudden gains reported lower levels of posttraumatic symptoms, F(1, 61) = 14.4, p     

Effects of psychotherapy for depression in children and adolescents: A meta-analysis.

Serious sequelae of youth depression, plus recent concerns over medication safety, prompt growing interest in the effects of youth psychotherapy. In previous meta-analyses, effect sizes (ESs) have averaged .99, well above conventional standards for a large effect and well above mean ES for other conditions. The authors applied rigorous analytic methods to the largest study sample to date and found a mean ES of .34, not superior but significantly inferior to mean ES for other conditions. Cognitive treatments (e.g., cognitive-behavioral therapy) fared no better than noncognitive approaches. Effects showed both generality (anxiety was reduced) and specificity (externalizing problems were not), plus short- but not long-term holding power. Youth depression treatments appear to produce effects that are significant but modest in their strength, breadth, and durability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)