Family processes are a risk factor for suicide but few studies target this domain. We evaluated the effectiveness of a family intervention, the Resourceful Adolescent Parent Program (RAP-P) in ...reducing adolescent suicidal behavior and associated psychiatric symptoms.
A preliminary randomized controlled trial compared RAP-P plus Routine Care (RC) to RC only, in an outpatient psychiatric clinic for N = 48 suicidal adolescents and their parents. Key outcome measures of adolescent suicidality, psychiatric disability, and family functioning were completed at pre-treatment, 3-month, and 6-month follow-up.
RAP-P was associated with high recruitment and retention, greater improvement in family functioning, and greater reductions in adolescents' suicidal behavior and psychiatric disability, compared to RC alone. Benefits were maintained at follow-up with a strong overall effect size. Changes in adolescent's suicidality were largely mediated by changes in family functioning.
The study provides preliminary evidence for the use of family-focused treatments for adolescent suicidal behavior in outpatient settings. Clinical trial registration information-Family intervention for adolescents with suicidal behaviour: A randomized controlled trial and mediation analysis; http://anzctr.org/; ACTRN12613000668707.
Summary In humans, oxytocin nasal administration reduces social-threat perception and improves processes involved in communication and the encoding of positive social cues. The aim of this study was ...to determine whether oxytocin given as an adjunct to exposure therapy improves treatment for social anxiety disorder (SAD) as indicated by a comprehensive set of symptom outcome measures. In a randomized, double-blind, placebo-controlled trial, we administered 24 IU of oxytocin or a placebo in combination with exposure therapy to twenty-five participants who met primary diagnosis for SAD. Participants administered with oxytocin showed improved positive evaluations of appearance and speech performance as exposure treatment sessions progressed. These effects did not generalize to improve overall treatment outcome from exposure therapy. Participants who received oxytocin or placebo reported similar levels of symptom reduction following treatment across symptom severity, dysfunctional cognition, and life-impairment measures. This study shows that the administration of oxytocin improves mental representations of self, following exposure therapy. These effects may be either short term or situation specific. Future research is now needed to determine whether oxytocin can enhance treatment outcomes for SAD when used with greater frequency, with a wider variety of social learning experiences, and in conjunction with interventions that more specifically target change in broader dysfunctional cognitions.
Background In nonhuman mammals, oxytocin has a critical role in peer recognition and social approach behavior. In humans, oxytocin has been found to enhance trust and the ability to interpret the ...emotions of others. It has been suggested that oxytocin may enhance facial processing by increasing focus on the eye region of human faces. Methods In a double-blind, randomized, placebo-controlled, between-subject design, we tracked the eye movements of 52 healthy male volunteers who were presented with 24 neutral human faces after intranasal administration of 24 IU oxytocin or placebo. Results Participants given oxytocin showed an increased number of fixations and total gaze time toward the eye region compared with placebo participants. Conclusions Oxytocin increases gaze specifically toward the eye region of human faces. This may be one mechanism by which oxytocin enhances emotion recognition, interpersonal communication, and social approach behavior in humans. Findings suggest a possible role for oxytocin in the treatment of disorders characterized by eye-gaze avoidance and facial processing deficits.
The last two decades have witnessed a surge in research investigating the application of oxytocin as a method of enhancing social behaviour in humans. Preliminary evidence suggests oxytocin may have ...potential as an intervention for autism. We evaluated a 5-day ‘live-in’ intervention using a double-blind randomized control trial. 38 male youths (7–16 years old) with autism spectrum disorders were administered 24 or 12 international units (depending on weight) intranasal placebo or oxytocin once daily over four consecutive days. The oxytocin or placebo was administered during parent–child interaction training sessions. Parent and child behaviours were assessed using parent reports, clinician ratings, and independent observations, at multiple time points to measure side-effects; social interaction skills; repetitive behaviours; emotion recognition and diagnostic status. Compared to placebo, intranasal oxytocin did not significantly improve emotion recognition, social interaction skills, or general behavioral adjustment in male youths with autism spectrum disorders. The results show that the benefits of nasal oxytocin for young individuals with autism spectrum disorders may be more circumscribed than suggested by previous studies, and suggest caution in recommending it as an intervention that is broadly effective.
This article introduces a novel hypothesis regarding amygdala function in psychopathy. The first part of this article introduces the concept of psychopathy and describes the main cognitive and ...affective impairments demonstrated by this population; that is, a deficit in fear-recognition, lower conditioned fear responses and poor performance in passive avoidance, and response-reversal learning tasks. Evidence for amygdala dysfunction in psychopathy is considered with regard to these deficits; however, the idea of unified amygdala function is untenable. A model of differential amygdala activation in which the basolateral amygdala (BLA) is underactive while the activity of the central amygdala (CeA) is of average to above average levels is proposed to provide a more accurate and up-to-date account for the specific cognitive and emotional deficits found in psychopathy. In addition, the model provides a mechanism by which attentional-based models and emotion-based models of psychopathy can coexist. Data to support the differential amygdala activation model are provided from studies from both human and animal research. Supporting evidence concerning some of the neurochemicals implicated in psychopathy is then reviewed. Implications of the model and areas of future research are discussed.
Summary Background Human research investigating the impact of intranasal oxytocin on psychological processes has accelerated over the last two decades. No review of side effects, subjective reactions ...and safety is available. Method A systematic review of 38 randomised controlled trials conducted between 1990 and 2010 that investigated the central effects of intranasal oxytocin was undertaken. A systematic search for reports of adverse reactions involving intranasal oxytocin was also completed. Results Since 1990, research trials have reported on N = 1529 (79% male) of which 8% were participants with developmental or mental health difficulties. Dosages ranged from 18 to 40 IU, mainly in single doses but ranged up to 182 administrations. Diverse methods have been used to screen and exclude participants, monitor side effects and subject reactions. Side effects are not different between oxytocin and placebo and participants are unable to accurately report on whether they have received oxytocin and placebo. Three case reports of adverse reactions due to misuse and longer-term use of intranasal oxytocin were reported. Conclusions The evidence shows that intranasal oxytocin: (1) produces no detectable subjective changes in recipients, (2) produces no reliable side-effects, and (3) is not associated with adverse outcomes when delivered in doses of 18–40 IU for short term use in controlled research settings. Future research directions should include a focus on the dosage and duration of use, and application with younger age groups, vulnerable populations, and with females.
There is limited prospective research on the relation between school connectedness (i.e., the extent to which students feel accepted, valued, respected, and included in the school) and mental health ...symptoms in adolescents. A sample of 2,022 students (999 boys and 1,023 girls) ages 12 to 14 years were measured at 2 time points (12 months apart) on school connectedness and mental health symptoms (general functioning, depression, and anxiety symptoms). School connectedness correlated extensively with concurrent mental health symptoms at both time points (between 38% and 55% covariation with depression, 26% to 46% with general functioning, and 9% and 16% for anxiety symptoms). Using hierarchical linear modeling, school connectedness also predicted depressive symptoms 1 year later for both boys and girls, anxiety symptoms for girls, and general functioning for boys, even after controlling for prior symptoms. The reverse, however, was not true: Prior mental health symptoms did not predict school connectedness 1 year later when controlling for prior school connectedness. Results suggest a stronger than previously reported association with school connectedness and adolescent depressive symptoms in particular and a predictive link from school connectedness to future mental health problems.
The treatment of conduct problems among children and adolescents with callous-unemotional (CU) traits has been subject to much speculation; however, treatment outcome research has been surprisingly ...limited and findings have been mixed. This review examines the research to date in this field as it pertains to two key questions. First, are CU traits associated with clinical outcomes and processes in the family based treatment of child and adolescent conduct problems? Second, can family based intervention produce change in CU traits? Using a systematic search strategy, we identified 16 treatment outcomes studies that can be brought to bear on these questions. These studies provide strong evidence of unique associations between CU traits and risk for poor treatment outcomes, while at the same time indicating that social-learning-based parent training is capable of producing lasting improvement in CU traits, particularly when delivered early in childhood. We discuss the potential for this emerging evidence base to inform the planning and delivery of treatments for clinic-referred children with CU traits, and detail an ongoing program of translational research into the development of novel interventions for this high-risk subgroup.
Parental discipline strategies are a necessary and critical aspect of positive child development. Their qualities confer risk versus protection for the development of mental health problems. Time-out ...from positive reinforcement is now one of the most common and well-researched discipline procedures across the world, with overwhelming evidence to support its efficacy and acceptability. It has also recently attracted considerable criticism from writers evoking child well-being considerations based on attachment theory. The main concern is that the removal of a child to time-out exposes the child to a break in attachment security and, for children with trauma histories, potentially causes harm. Here, we consider what a discipline strategy should be from a mental health perspective and, utilizing the best available models of developmental mental health and psychopathology, derive five axioms for judging and guiding the worth and acceptability of any particular discipline strategy. We then use these axioms to evaluate and specify how time-out can be used in a way that maximizes positive child outcomes, and then review its use with children who have experienced complex trauma. We show that time-out, when conceptualized and enacted consistently with contemporary models of learning, attachment, self-regulation, and family systems theory, is actually a positive perturbation to these systems that can rapidly remediate problems the child is experiencing, and thereby generally enhances child well-being. Clinical, research, and policy implications are briefly discussed.
•Empathy and callous unemotional traits in conduct problems.•Empathy deficits in children with conduct problems are heterogeneous.•Empathy development is associated with cognitive and ...socio-environmental processes.•Neurochemical systems implicated in empathy deficits specific to callous-unemotional traits include oxytocin and serotonin.
The notion that antisocial behavior reflects failures of empathy has a long history in the clinical literature, yet only recently has evidence emerged to support neuroscientific accounts of empathy and the development of child conduct problems. Much of this evidence has come from research into callous-unemotional traits, which correspond to the affective component of psychopathy and therefore encompass deficits in empathy within a broader cluster of emotional impairments. In this review we integrate current evidence concerning the biobehavioral bases of empathy and callous-unemotional traits, and discuss how it may inform models of heterogeneous subgroups of individuals with early onset conduct problems. We argue that somewhat distinct failures of empathy map onto distinct risk pathways to early onset conduct problems, and that these pathways may be best understood by examining empathy in terms of cognitive and environmental prerequisites and the various neurochemical systems implicated therein.
PDF
