Identifying and predicting adolescent smokers' developmental trajectories

Very few studies have defined trajectories of smoking. In the present study, we modeled growth in adolescent smoking and empirically identified prototypical trajectories. We conceptualized escalation of smoking as a growth process and modeled rates of change and heterogeneity of these patterns using latent growth mixture modeling. The analysis identified six trajectories with low ambiguity about group membership (early rapid escalators, late rapid escalators, late moderate escalators, late slow escalators-smokers, stable puffers, and late slow escalators-puffers). A trajectory of quitters was not identified. We also examined predictors of the smoking trajectories. The predictors were assessed across the adolescent years and included variables related to smoking and other substance use, as well as a range of variables related to sociodemographic factors and mental health. Observed change in the pattern of predictors across age has implications for the mechanism of effect of these variables in relation to smoking trajectories, including predictors that differentiated among daily smokers, variables that may determine the trajectory (e.g., friends smoking), and variables that may result from the trajectory (e.g., marijuana use, less attachment to friends).

Efficacy of sertraline in a 12-week trial for generalized anxiety disorder

Objective: Sertraline's efficacy and tolerability in treating generalized anxiety disorder were evaluated. Method: Adult outpatients with DSM-IV generalized anxiety disorder and a total score of 18 or higher on the Hamilton Anxiety Rating Scale were eligible. After a 1-week single-blind placebo lead-in, patients were randomly assigned to 12 weeks of double-blind treatment with placebo (N=188, mean baseline anxiety score=25) or flexible doses (50-150 mg/day) of sertraline (N=182, mean anxiety score=25). The primary outcome measure was baseline-to-endpoint change in the Hamilton anxiety scale total score. A secondary efficacy measure was the Clinical Global Impression (CGI) improvement score; response was defined as a score of 2 or less. Results: Sertraline patients had significantly greater improvement than placebo patients on all efficacy measures at week 4. Analysis of covariance of the intent-to-treat group at endpoint (with the last observation carried forward) showed a significant difference in the decrease from baseline of the least-square mean total score on the Hamilton anxiety scale between sertraline (mean=11.7) and placebo (mean=8.0). Significantly greater endpoint improvement with sertraline than placebo was obtained for mean scores on the Hamilton anxiety scale psychic factor (6.7 versus 4.1) and somatic factor (5.0 versus 3.9). The rate of responders, based on CGI improvement and last observation carried forward, was significantly higher for sertraline (63%) than placebo (37%). Sertraline was well tolerated; 8% of patients versus 10% for placebo dropped out because of adverse events. Conclusions: Sertraline appears to be efficacious and well tolerated in the treatment of generalized anxiety disorder.

The role of drinking restraint in alcohol dependence: validation of the temptation and restraint inventory in an alcohol dependent sample

Objective: The Temptation and Restraint Inventory (TRI) is commonly used to measure drinking restraint in relation to problem drinking behavior. However, as yet the TRI has not been validated in a clinical group with alcohol dependence. Method: Male (n = 111) and female (n = 57) inpatients with DSM-IV diagnosed alcohol dependence completed the TRI and measures of problem drinking severity, including the Alcohol Dependence Scale and the quantity, frequency and week total of alcohol consumed. Results: The factor structure of the TRI was replicated in the alcohol dependent sample. Cognitive Emotional Preoccupation (CEP), one of the two higher order factors of the TRI, demonstrated sound predictive power toward all dependence severity indices. The other higher order factor, Cognitive Behavioral Control (CBC), was related to frequency of drinking. There was limited support for the CEP/CBC interactional model of drinking restraint. Conclusions: Although the construct validity of the TRI was sound, the measure appears more useful in understanding the development, maintenance and severity of alcohol-related problems in nondependent drinkers. The TRI may show promise in detecting either continuous drinking or heavy episodic type dependent drinkers.

The implications of simultaneous smoking initiation for inferences about the genetics of smoking behavior from twin data

We examined early social influences across stages of smoking within the context of a twin study using an environmental exposure specific to smoking: whether twins started smoking at the same time (simultaneous smoking initiation: SSI). We expected that SSI would be a good index of shared social influences on smoking initiation. Rates of SSI were indeed significantly higher in MZ twins and in twins who shared peers and classes, as well as in male twins. With the exception of regular smoking in females, we found no significant difference in estimates of genetic and environmental parameters between SSI and non-SSI pairs for any of the smoking measures that we examined (DSM-IV and Fagerstrom HSI measures of nicotine dependence; DSM-IV nicotine withdrawal; heavy smoking; and in males, regular smoking). For regular smoking in females, allowing for additional shared environmental influences associated with SSI only modestly reduced our estimates of additive genetic variance (56% vs. 68%). These results indicate the important social influences that may occur for smoking initiation do not appear to seriously bias estimates of genetic effects on later stages of smoking.

Evidence for retarded extinction of aversive learning in anxious children

The habituation to intense acoustic stimuli and the acquisition of differentially conditioned fear were assessed in 53 clinically anxious and 30 non-anxious control children and young adolescents. Anxious children tended to show larger electrodermal responses during habituation, but did not differ in blink startle latency or magnitude. After acquisition training, non-anxious children rated the CS + as more fear provoking and arousing than the CS- whereas the ratings of anxious children did not differ. However, anxious children rated the CS + as more fear provoking after extinction, a difference that was absent in non-anxious children. During extinction training, anxious children displayed larger blink magnitude facilitation during CS + and a trend towards larger electrodermal responses, a tendency not seen in nonanxious children. These data suggest that extinction of fear learning is retarded in anxious children. (c) 2005 Elsevier Ltd. All rights reserved.

Obsessive-compulsive disorder across developmental trajectory: Cognitive processing of threat in children, adolescents and adults

Background. While the cognitive theory of obsessive-compulsive disorder (OCD) is one of the most widely accepted accounts of the maintenance of the disorder in adults, no study to date has systematically evaluated the theory across children, adolescence and adults with OCD. Method. This paper investigated developmental differences in the cognitive processing of threat in a sample of children, adolescents and adults with OCD. Using an idiographic assessment approach, as well as self-report questionnaires, this study evaluated cognitive appraisals of responsibility, probability, severity, thought-action fusion (TAF), thought-suppression, self-doubt and cognitive control. It was hypothesised that there would be age related differences in reported responsibility for harm, probability of harm, severity of harm, thought suppression, TAR self-doubt and cognitive control. Results. Results of this study demonstrated that children with OCD reported experiencing fewer intrusive thoughts, which were less distressing and less uncontrollable than those experienced by adolescents and adults with OCD. Furthermore, responsibility attitudes, probability biases and thought suppression strategies were higher in adolescents and adults with OCD. Cognitive processes of TAF, perceived severity of harm, self-doubt and cognitive control were found to be comparable across age groups. Conclusions. These results suggest that the current cognitive theory of OCD needs to address developmental differences in the cognitive processing of threat. Furthermore, for a developmentally sensitive theory of OCD, further investigation is warranted into other possible age related maintenance factors. Implications of this investigation and directions for future research are discussed.

COMPREENSÃO DO FUNCIONAMENTO MENTAL EM PACIENTES COM ACIDENTE CEREBROVASCULAR: UMA CONTRIBUIÇÃO DA PSICOLOGIA DA SAÚDE

O acidente cerebrovascular é uma doença de grande incidência no Brasil e no mundo. As pessoas que sofreram este tipo de acometimento podem apresentar seqüelas variadas, como motoras, cognitivas, sensoriais, sociais, afetivo-emocionais e transtornos psiquiátricos, levando a graus variados de dependência. Sendo assim, um estudo psicológico se faz importante, pois estas pessoas sofrerão mudanças em suas rotinas e no seu mundo interno.O presente trabalho trata-se de uma pesquisa clínico qualitativa, e teve como objetivos investigar as repercussões psicológicas de pacientes adultos que sofreram acidente cerebrovascular; compreender o funcionamento mental, a deterioração neuropsicológica e a adaptação humana desses pacientes, através da Escala de Avaliação Global do Funcionamento, do Desenho da Figura Humana, e da Escala do Diagnóstico Adaptativo Operacionalizado; compreender o sofrimento psicológico em narrativas da entrevista psicológica dessas pessoas e investigar como os indivíduos contam sua própria história numa compreensão psicossomática e psicanalítica. Para isso, utilizou-se o referencial teórico da Psicanálise e as concepções de Neuropsicanálise e Psicossomática. Foram analisados os relatos de cinco pacientes em tratamento num centro de reabilitação. Observou-se que por tratar-se de uma lesão cerebral, as repercussões psicológicas de quem sofreu acidente cerebrovascular devem ser observadas do ponto de vista neuropsicológico e a dinâmica afetivo-emocional. Os dados do Eixo V do DSM-IV, Escala de Avaliação Global do Funcionamento, e da Escala do Diagnóstico Adaptativo Operacionalizado de Ryad Simon apresentaram forte correlação estatística, embora a última seja mais compreensiva do ponto de vista psicanalítico; todos os pacientes apresentaram Adaptação Ineficaz. Quanto ao Desenho da Figura Humana, questionou-se a fidedignidade deste tipo de técnica nessa população, uma vez que os dados de organicidade interferem bastante. A história construída foi um instrumento importante para investigar como o indivíduo que sofreu acidente cerebrovascular contou sua própria história, seus mecanismos de defesa e as fantasias inconscientes, surgindo nesses relatos histórias importantes de depressão. Os mecanismos de defesa predominante no funcionamento mental desses pacientes foram a repressão e a desvalorização, no funcionamento neurótico, e a onipotência no funcionamento psicótico.(AU)

Abnormal amygdala-prefrontal effective connectivity to happy faces differentiates bipolar from major depression

Background - Bipolar disorder is frequently misdiagnosed as major depressive disorder, delaying appropriate treatment and worsening outcome for many bipolar individuals. Emotion dysregulation is a core feature of bipolar disorder. Measures of dysfunction in neural systems supporting emotion regulation might therefore help discriminate bipolar from major depressive disorder. Methods - Thirty-one depressed individuals—15 bipolar depressed (BD) and 16 major depressed (MDD), DSM-IV diagnostic criteria, ages 18–55 years, matched for age, age of illness onset, illness duration, and depression severity—and 16 age- and gender-matched healthy control subjects performed two event-related paradigms: labeling the emotional intensity of happy and sad faces, respectively. We employed dynamic causal modeling to examine significant among-group alterations in effective connectivity (EC) between right- and left-sided neural regions supporting emotion regulation: amygdala and orbitomedial prefrontal cortex (OMPFC). Results - During classification of happy faces, we found profound and asymmetrical differences in EC between the OMPFC and amygdala. Left-sided differences involved top-down connections and discriminated between depressed and control subjects. Furthermore, greater medication load was associated with an amelioration of this abnormal top-down EC. Conversely, on the right side the abnormality was in bottom-up EC that was specific to bipolar disorder. These effects replicated when we considered only female subjects. Conclusions - Abnormal, left-sided, top-down OMPFC–amygdala and right-sided, bottom-up, amygdala–OMPFC EC during happy labeling distinguish BD and MDD, suggesting different pathophysiological mechanisms associated with the two types of depression.

Elevated amygdala activity to sad facial expressions:a state marker of bipolar but not unipolar depression

Background - Difficulties in emotion processing and poor social function are common to bipolar disorder (BD) and major depressive disorder (MDD) depression, resulting in many BD depressed individuals being misdiagnosed with MDD. The amygdala is a key region implicated in processing emotionally salient stimuli, including emotional facial expressions. It is unclear, however, whether abnormal amygdala activity during positive and negative emotion processing represents a persistent marker of BD regardless of illness phase or a state marker of depression common or specific to BD and MDD depression. Methods - Sixty adults were recruited: 15 depressed with BD type 1 (BDd), 15 depressed with recurrent MDD, 15 with BD in remission (BDr), diagnosed with DSM-IV and Structured Clinical Interview for DSM-IV Research Version criteria; and 15 healthy control subjects (HC). Groups were age- and gender ratio-matched; patient groups were matched for age of illness onset and illness duration; depressed groups were matched for depression severity. The BDd were taking more psychotropic medication than other patient groups. All individuals participated in three separate 3T neuroimaging event-related experiments, where they viewed mild and intense emotional and neutral faces of fear, happiness, or sadness from a standardized series. Results - The BDd—relative to HC, BDr, and MDD—showed elevated left amygdala activity to mild and neutral facial expressions in the sad (p < .009) but not other emotion experiments that was not associated with medication. There were no other significant between-group differences in amygdala activity. Conclusions - Abnormally elevated left amygdala activity to mild sad and neutral faces might be a depression-specific marker in BD but not MDD, suggesting different pathophysiologic processes for BD versus MDD depression.

Abnormally increased effective connectivity between parahippocampal gyrus and ventromedial prefrontal regions during emotion labeling in bipolar disorder

Emotional liability and mood dysregulation characterize bipolar disorder (BD), yet no study has examined effective connectivity between parahippocampal gyrus and prefrontal cortical regions in ventromedial and dorsal/lateral neural systems subserving mood regulation in BD. Participants comprised 46 individuals (age range: 18-56 years): 21 with a DSM-IV diagnosis of BD, type I currently remitted; and 25 age- and gender-matched healthy controls (HC). Participants performed an event-related functional magnetic resonance imaging paradigm, viewing mild and intense happy and neutral faces. We employed dynamic causal modeling (DCM) to identify significant alterations in effective connectivity between BD and HC. Bayes model selection was used to determine the best model. The right parahippocampal gyrus (PHG) and right subgenual cingulate gyrus (sgCG) were included as representative regions of the ventromedial neural system. The right dorsolateral prefrontal cortex (DLPFC) region was included as representative of the dorsal/lateral neural system. Right PHG-sgCG effective connectivity was significantly greater in BD than HC, reflecting more rapid, forward PHG-sgCG signaling in BD than HC. There was no between-group difference in sgCG-DLPFC effective connectivity. In BD, abnormally increased right PHG-sgCG effective connectivity and reduced right PHG activity to emotional stimuli suggest a dysfunctional ventromedial neural system implicated in early stimulus appraisal, encoding and automatic regulation of emotion that may represent a pathophysiological functional neural mechanism for mood dysregulation in BD.

Elevated left and reduced right orbitomedial prefrontal fractional anisotropy in adults with bipolar disorder revealed by tract-based spatial statistics

Context - Diffusion tensor imaging (DTI) studies in adults with bipolar disorder (BD) indicate altered white matter (WM) in the orbitomedial prefrontal cortex (OMPFC), potentially underlying abnormal prefrontal corticolimbic connectivity and mood dysregulation in BD. Objective - To use tract-based spatial statistics (TBSS) to examine WM skeleton (ie, the most compact whole-brain WM) in subjects with BD vs healthy control subjects. Design - Cross-sectional, case-control, whole-brain DTI using TBSS. Setting - University research institute. Participants - Fifty-six individuals, 31 having a DSM-IV diagnosis of BD type I (mean age, 35.9 years [age range, 24-52 years]) and 25 controls (mean age, 29.5 years [age range, 19-52 years]). Main Outcome Measures - Fractional anisotropy (FA) longitudinal and radial diffusivities in subjects with BD vs controls (covarying for age) and their relationships with clinical and demographic variables. Results - Subjects with BD vs controls had significantly greater FA (t > 3.0, P = .05 corrected) in the left uncinate fasciculus (reduced radial diffusivity distally and increased longitudinal diffusivity centrally), left optic radiation (increased longitudinal diffusivity), and right anterothalamic radiation (no significant diffusivity change). Subjects with BD vs controls had significantly reduced FA (t > 3.0, P = .05 corrected) in the right uncinate fasciculus (greater radial diffusivity). Among subjects with BD, significant negative correlations (P < .01) were found between age and FA in bilateral uncinate fasciculi and in the right anterothalamic radiation, as well as between medication load and FA in the left optic radiation. Decreased FA (P < .01) was observed in the left optic radiation and in the right anterothalamic radiation among subjects with BD taking vs those not taking mood stabilizers, as well as in the left optic radiation among depressed vs remitted subjects with BD. Subjects having BD with vs without lifetime alcohol or other drug abuse had significantly decreased FA in the left uncinate fasciculus. Conclusions - To our knowledge, this is the first study to use TBSS to examine WM in subjects with BD. Subjects with BD vs controls showed greater WM FA in the left OMPFC that diminished with age and with alcohol or other drug abuse, as well as reduced WM FA in the right OMPFC. Mood stabilizers and depressed episode reduced WM FA in left-sided sensory visual processing regions among subjects with BD. Abnormal right vs left asymmetry in FA in OMPFC WM among subjects with BD, likely reflecting increased proportions of left-sided longitudinally aligned and right-sided obliquely aligned myelinated fibers, may represent a biologic mechanism for mood dysregulation in BD.

Operant and respondent procedures to establish social stimuli as reinforcers in children with autism

According to the DSM-IV- TR (American Psychiatric Association, 2000), one of the core deficits in autism is in the impairment of social interaction. Some have suggested that underlying these deficits is the reality that individuals with autism do not find social stimuli to be as reinforcing as other types of stimuli (Dawson, 2008). An interesting and growing body of literature supports the notion that symptoms in autism may be caused by a general reduction in social motivation (Chevallier et al., 2012). A review of the literature suggests that social orienting and social motivation are low in individuals with autism, and including social motivation as a target for therapeutic intervention should be pursued (Helt et al., 2008). Through our understanding of learning processes, researchers in behavior analysis and related fields have been able to use conditioning procedures to change the function of neutral or ineffective stimuli, including tokens (Ayllon & Azrin, 1968), facial expressions (Gewirtz & Pelaez-Nogueras, 1992) and praise (Dozier et al., 2012). The current study aimed to use operant and respondent procedures to condition social stimuli that were empirically shown to not be reinforcing prior to conditioning. Further, this study aimed to compare the two procedures in their effectiveness to condition social stimuli to function as reinforcers, and in their maintenance of effects over time. Using a multiple-baseline, multi-element design, one social stimulus was conditioned under each procedure to compare the different response rates following conditioning. Finally, the study sought to determine if conditioning social stimuli to function as reinforcers had any effect on the social functioning of young children with autism. Six children diagnosed with autism between the ages of 18 months and 3 years participated. Results show that the respondent procedure (pairing) resulted in more robust and enduring effects than the operant procedure (Sd procedure). Results of a social communication assessment (ESCS, Mundy et al., 2003) before and after conditioning demonstrate gains in all areas of social communication, particularly in the areas of initiating and responding to joint attention.^

Hispanic Adolescents With Severe Substance Abuse Issues: Parental Involvement, Acculturation-Related Factors and Attachment

The main objective of the study was to investigate the relationship between parent-related, acculturation-related, and substance use-related variables found within individual, familial/parental, peer and school adolescent ecological domains, in a clinical sample (i.e. adolescents who met criteria for a Diagnostic Statistical Manual-IV [DSM-IV] clinical diagnosis of substance abuse/dependence) of Hispanic adolescents from Miami, Florida. The sample for this study consisted of 94 adolescent-mother pairs. The adolescent sample was 65% male, and 35% female, with a mean age of 15 years. More than half of the adolescents were born in the United States (60%) and had resided in the U.S. for an average of 12 years; 80% of the caregivers (primarily mothers) were foreign-born and lived in the U.S. for an average of 21 years. Correlation and hierarchical regression were used to answer the research questions. The findings indicate that the hypothesized model and corresponding anticipated effect of the relationship between parental school and peer involvement on adolescents’ frequency of alcohol, marijuana and cocaine use was not supported by the data. Parental “acculturation-related” variables did not explain any of the variance in adolescent substance use frequency in this sample. Mediation and moderation models were not supported either. However, some interesting relationships were found: The larger the acculturation gap, the lower the parental involvement in school tended to be (r = -.21, p < .05). Adolescents who experienced a greater acculturation gap with their parents (-.81, p >.01) had an earlier onset of marijuana (-.33, p < .01) and cocaine use (r = -.24, p .05), they also reported using marijuana more frequently than females (.21, p >.05).

Organización cerebral en el reconocimiento de caras conocidas y no conocidas en niños con autismo

Disponemos hoy de dos sistemas de clasificación diagnóstica: uno el establecido por la Asociación Psiquiátrica Norteamericana, el Manual Diagnóstico y Estadístico de Trastornos Mentales, DSM-IV-TR, (APA, 2002); y otro, el desarrollado por la Organización Mundial de la Salud, la Clasificación Internacional de Enfermedades CIE- 10 (OMS, 1992) en su décima versión, que se utiliza de manera oficial para codificar las enfermedades en muchos países. En el DSM-IV-TR, el autismo viene incluido dentro del grupo de los trastornos generalizados del desarrollo (TGD) como una categoría diagnóstica que tiene su principal afectación en la alteración cualitativa de la interacción social, la flexibilidad, los intereses restringidos, el lenguaje y la imaginación o el juego. En los últimos años, y muy usado actualmente, se incorpora el término trastornos del espectro autista (TEA). Además de los aspectos ya aceptados en la denominación TGD, el término TEA resalta la noción dimensional de un “continuo” (no una categoría), en el que se altera cualitativamente un conjunto de capacidades en la interacción social, la comunicación y la imaginación. Esta semejanza no es incompatible con la diversidad del colectivo: diversos trastornos, diversa afectación de los síntomas clave, desde los casos más acentuados a aquellos rasgos fenotípicos rozando la normalidad; desde aquellos casos asociados a discapacidad intelectual marcada, a otros con alto grado de inteligencia; desde unos vinculados a trastornos genéticos o neurológicos, a otros en los que aún no somos capaces de identificar las anomalías biológicas subyacentes...

Del pictograma a la imagen: herramientas de comunicación y lenguaje en personas con síndrome de Asperger a través de recursos visuales para la inclusión social

Se presenta en este texto, una introducción al Síndrome de Asperger y aquellas características que lo distinguen, con el fin de conocer un poco más, en qué consiste este Trastorno Generalizado del Desarrollo (TGD). Además, se pretende facilitar cuales son las herramientas de comunicación y lenguaje más aptas para la enseñanza y aprendizaje del sujeto, haciendo hincapié en los recursos visuales, audiovisuales y artísticos como herramientas de aprendizaje para su inclusión social en cualquier ámbito de la sociedad (colegios, institutos, asociaciones, universidades o administraciones).