Oppositional defiant disorder (ODD) frequently co-occurs with depression in youth, and it has been proposed that ODD Angry/Irritable Mood symptoms predict depression in these youth. Another ...explanation is that the ODD Angry/Irritable Mood dimension is a component of a broader emotion dysregulation syndrome. This study examined the relationship of ODD Angry/Irritable Mood symptoms with depression, and the Child Behavior Check List (CBCL) Dysregulation Profile with co-occurring ODD and depression in clinic-referred youth. Of 310 youth referred to an outpatient clinic, 86 were diagnosed with ODD without depression, and 78 were diagnosed with co-occurring ODD and depression. These groups did not differ in number of ODD Angry/Irritable Mood symptoms, and ODD affective symptoms showed a low correlation with youth-reported depression and parent- reported CBCL Anxious/Depressed symptoms. Logistic regression analysis with ODD Angry/Irritable Mood symptoms did not differentiate youth who were diagnosed with ODD without depressive disorder from youth who were diagnosed with co-occurring ODD and depression. The 55 youth who fit the CBCL – Dysregulation Profile were more likely to be diagnosed with depression than youth who did not fit the profile. Logistic regression analysis with this profile differentiated youth with co-occurring ODD and depression from youth diagnosed with ODD without co-occurring depression. Present results did not support the hypothesis that ODD Angry/Irritable Mood symptoms are differentially associated with depression in clinic-referred youth with ODD. However, the results did support the hypothesis that the parent-report CBCL dysregulation profile differentiates youth with co-occurring ODD and depression from ODD youth without depression.
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DOBA, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, ODKLJ, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, SIK, UILJ, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Objective: To describe diagnostic and psychotropic medication prescription characteristics among college students referred by college counseling centers for psychopharmacologic evaluation. ...Participants: Participants were 540 college students referred by 6 college counseling centers in Massachusetts between November 2005 and May 2011. Methods: Students completed self-report measures of depression, anxiety, suicidal ideation and attempts, and substance use. Information regarding DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) diagnosis, previous history of medication prescription, and current psychotropic medication(s) prescribed by the consulting psychiatrist was obtained from medical records. Results: Depression, anxiety, and attention-deficit/hyperactivity disorder (ADHD) were the most common psychiatric problems identified in students. Half of these students had been prescribed mediation prior to evaluation. Antidepressant medication was the most frequently prescribed medication. A large proportion of students reported previous thoughts of suicide, and 12% had made at least 1 suicide attempt. Conclusions: Depression, anxiety, and ADHD are common among students referred by college counseling centers for medication evaluation and treatment.
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DOBA, FSPLJ, IJS, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Objective: The goal was to examine whether anxiety modifies the risk for, or severity of, conduct problems in children with ADHD. Method: Assessment included both categorical and dimensional measures ...of ADHD, anxiety, and conduct problems. Analyses compared conduct problems between children with ADHD features alone versus children with co-occurring ADHD and anxiety features. Results: When assessed by dimensional rating scales, results showed that compared with children with ADHD alone, those children with ADHD co-occurring with anxiety are at risk for more intense conduct problems. When assessment included a Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) diagnosis via the Schedule for Affective Disorders and Schizophrenia for School Age Children–Epidemiologic Version (K-SADS), results showed that compared with children with ADHD alone, those children with ADHD co-occurring with anxiety neither had more intense conduct problems nor were they more likely to be diagnosed with oppositional defiant disorder or conduct disorder. Conclusion: Different methodological measures of ADHD, anxiety, and conduct problem features influenced the outcome of the analyses.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
Substance use disorders and post-traumatic stress disorder (PTSD) often co-occur, along with depression and anger. Despite evidence that Prolonged Exposure Therapy is effective for individuals with ...co-occurring PTSD and SUD when PE is implemented alongside SUD treatment, clinicians have been reluctant to offer PE or other trauma-focused therapies to individuals with co-occurring PTSD and SUD because of the belief that increased emotional distress would be counter-therapeutic for individuals in early recovery. A widely held explanation for the high degree of comorbidity is that individuals with PTSD use substances to reduce or avoid painful and disturbing PTSD symptoms. This case study describes the implementation and outcome of PE therapy with a 32-year-old man who had been admitted to a residential substance use treatment program for Latino males. The client had a long history of polysubstance use and severe PTSD. The client was homeless and reported significant depressive and anger symptoms. Assessment of PTSD revealed that he was using heroin and cocaine to avoid painful memories of a traumatic event that had occurred several years prior to his admission to this treatment program. Because the client reported using these substances to reduce emotional distress, PE was chosen as the PTSD intervention. During PE Therapy the client reported no thoughts or urges to use substances and at discharge from residential treatment he reported no problems with PTSD or depression. The client maintained all gains at 1-year follow-up, when he also reported that he was working full time and had remained abstinent since he completed treatment.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
ABSTRACTThis study examined whether atypical/severe nonsuicidal self-injury (NSSI; e.g., foreign body ingestion, cutting necessitating sutures) serves as a marker of severe psychopathology among 467 ...adult community mental health clients (n = 33 with an atypical/severe NSSI history). Information regarding psychiatric risk indicators was extracted from participants’ psychiatric records. Generalized linear models with negative binomial distribution and log link function, as well as chi-square tests, were used to address study aims. Clients with a lifetime atypical/severe NSSI history met criteria for a significantly greater number of psychiatric risk indicators than clients with a lifetime history of common NSSI only; however, these clients were not significantly more likely to report recent suicidal actions. Individuals with an atypical/severe NSSI history may demonstrate more severe psychopathology than those with a history of common NSSI only. Thus, it may be clinically useful to consider individuals with an atypical/severe NSSI history as a high-risk subgroup.
Objective: We describe interactions among factors that contribute to the development of conduct problems among children with ADHD. Method: An integrative developmental psychopathology analysis ...combines various approaches and posits one model of how diverse risk factors operate together to contribute to the development of conduct problems among children with ADHD. Results: Substantial genetic risk increases covariation between ADHD and conduct problems. Candidate genes are associated with CNS monoaminergic neurotransmission. Subsequent neurodevelopmental impairment interferes with executive function, with impaired verbal working memory playing an important role. Parent/child bi-directional influences exacerbate the risk for conduct problems when ADHD symptoms increase the likelihood of a coercive parenting style. Parent stress in reaction to child comorbid ADHD and conduct problems, and parent attribution for the child’s conduct problem behavior, add to the potential for coercion and reduce constructive parent-child interaction that might otherwise enhance the development of verbal working memory. Conclusion: In an integrated manner, these variables increase the risk that a child with ADHD will subsequently develop conduct problems.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
This study investigated cultural differences in beliefs about the etiology and management of OCD. Participants were 428 individuals from 13 countries in North America, Western Europe and South Asia ...who completed a questionnaire about a hypothetical individual who experienced OCD. Principal components analysis of the questionnaire items identified four factors; comparison of the four subscales revealed significant cross-cultural differences in how participants viewed the individual with OCD and ideas about how to help someone with the disorder. Compared to individuals in the USA and Western Europe, participants in East Asia had a more negative view of the person with OCD, were more likely to blame the person, to consider the obsessions and compulsions to be part of the individual's personality and to recommend that the person not seek help from others. Participants from East Asian countries also were more likely to recommend alternative therapies like acupuncture and taking herbal medicines. Participants from Western countries had a more favourable view of psychosocial influences and psychosocial interventions for these problems.
Objective: In children with ADHD who have comorbid disruptive behavior diagnoses distinctions between oppositional defiant disorder (ODD) and conduct disorder (CD) remain unclear. The authors ...investigate differences between ODD and CD in a large clinical sample of children with ADHD. Method: Consecutively referred and systematically assessed male children and adolescents with either ADHD (n = 65), ADHD with ODD (n = 85), or ADHD with CD (n = 50) were compared using structured diagnostic interviews and parent, teacher, and clinician rating scales. Results: In children with ADHD, significant differences emerged between ODD and CD in the domains of delinquency, overt aggression, and ADHD symptom severity; ADHD with CD was most severe, followed by ADHD with ODD, and ADHD had the least severe symptoms. Distinctions between ADHD with CD and the other two groups were found for parenting, treatment history, and school variables. Conclusion: Within the limits of a cross-sectional methodology, results support clinically meaningful distinctions between ODD and CD in children with ADHD. (J. of Att. Dis. 2008; 12(2) 126-134)
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
College students’ need for mental health care has increased dramatically, leaving campus counseling and mental health centers struggling to meet the demand. This has led to the investigation and ...development of extra-center, population-based interventions. Student-to-student support programs are but one example. Students themselves are a plentiful, often-untapped resource that extends the reach of mental health services on campus. Student-to-student programs capitalize on students’ natural inclination to assist their peers. A brief review of the prevalence and effects of mental disorders in the college population is provided, followed by a broad overview of the range of peer-to-peer programs that can be available on college campuses. Two innovative programs are highlighted: (1) a hospital- and community-based program, the College Mental Health Program (CMHP) at McLean Hospital, and 2) the Student Support Network (SSN) at Worcester Polytechnic Institute. The subsequent section reviews the literature on peer-to-peer programs for students with serious and persistent mental illness for which there is a small but generally positive body of research. This lack of an empirical basis in college mental health leads the authors to argue for development of broad practice-research networks.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
The present study involved detailed chart review for a sample of college students referred to a psychiatrist for pharmacologic evaluation to obtain information about clinical decisions to prescribe ...antipsychotic medication. Six colleges and universities referred 540 students to an off-campus consulting psychiatrist, and 40 of these students (7.4%) had been prescribed antipsychotic medication at some point in their treatment. Results indicated that approximately 33% of students who had been prescribed an atypical antipsychotic had a diagnosis consistent with FDA-approved use. In addition, roughly 33% of students who had been prescribed an atypical antipsychotic had diagnoses (e.g., eating or anxiety disorders) for which there is weak or little empirical evidence that these agents are effective. Another 33% of the sample presented with an uncertain or unusual combination of symptoms that were difficult to diagnose. Even though this study found that off-label use of atypical antipsychotics was common, only one such use seemed to deviate from accepted standards of care. The present findings are consistent with other research in showing that atypical antipsychotics often are used despite a lack sound evidence of their effectiveness. These findings are consistent with other research that atypical antipsychotics are overprescribed for young people despite limited evidence for their effectiveness, and demonstrate that this pattern may continue with college students.
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BFBNIB, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
