Cenesthopathy in adolescence: An appraisal of diagnostic overlaps along the anxiety–hypochondriasis–psychosis spectrum

Objective To discuss the diagnostic validity of unusual bodily perceptions along the spectrum from age-specific, often transitory and normal, to pathological phenomena in adolescence to hypochondriasis and finally to psychosis. Methods Critical literature review of the cornerstone diagnostic groups along the spectrum embracing anxiety and cenesthopathy in adolescence, hypochondriasis, and cenesthopathy and psychosis, followed by a discussion of the diagnostic overlaps along this spectrum. Results The review highlights significant overlaps between the diagnostic cornerstones. It is apparent that adolescents with unusual bodily perceptions may conceptually qualify for more than one diagnostic group along the spectrum. To determine whether cenesthopathies in adolescence mirror emerging psychosis, a number of issues need to be considered, i.e. age and mode of onset, gender, level of functioning and drug use. The role of overvalued ideas at the border between hypochondriasis and psychosis must be considered. Conclusion As unusual bodily symptoms may in some instances meet formal psychosis risk criteria, a narrow understanding of these symptoms may lead to both inappropriate application of the new DSM-5 attenuated psychosis syndrome and of treatment selection. On the other hand, the possibility of a psychotic dimension of unusual bodily symptoms in adolescents must always be considered as most severe expression of the cenesthopathy spectrum.

Ethnic comparisons of adolescent sexual risk -taking and preventive behavior

For adolescents, unprotected sexual intercourse is the primary cause of sexually transmitted disease (STD), including Human Immunodeficiency Virus (HIV) infection (virus which causes Acquired Immunodeficiency Syndrome (AIDS)), and pregnancy. Although many studies on adolescent sexual behavior have addressed racial/ethnic differences, few studies have examined the relation between race/ethnicity while controlling for other sociocultural and psychosocial variables. The purpose of this study is to examine the relationship between racial/ethnic categories and selected sociocultural and psychosocial variables, with reported adolescent sexual risk-taking and preventive behavior.^ A self-administered questionnaire was used to collect information from 3132 students in a Texas school district (Section 3.5.2). The instrument contained approximately 100 questions on demographic characteristics, sexual behavior, and psychosocial determinants of sexual behavior. Based on the findings of this study, the following major conclusions are made: (1) There are differences in reported sexual risk-taking and preventive behavior among Black, Hispanic and White adolescents in this study. The stratified analysis by gender further suggests significant gender differences in reported sexual behavior among the three racial/ethnic groups. (2) Gender, living arrangement, academic grades, and language spoken at home modified the association between reported sexual risk-taking and preventive behavior and race/ethnicity in this study. This suggests that these sociocultural variables should be considered in future research and practice involving multicultural populations. (3) There are differences in selected psychosocial determinants among the three racial/ethnic groups and between males and females. These differences were consistent with the reported sexual risk-taking and preventive behaviors among race/ethnicity and gender for adolescents in this study. The findings support the consideration of psychosocial determinants in research and interventions addressing adolescent sexual behavior among different racial/ethnic groups.^ Based on the results of this study, two recommendations for practice are made. First, health professionals developing interventions for adolescents from different cultural backgrounds and gender need to be familiar with the specific sociocultural and psychosocial factors which will reduce risky sexual behavior, and promote protective behavior. Second, the need for immediate, realistic, and continuous HIV/STD and pregnancy prevention programs for children and adolescents should be considered. ^

Population based study of risk factors for underdiagnosis of asthma in adolescence: Odense schoolchild study

Objective: To describe factors related to underdiagnosis of asthma in adolescence.

Asthma and internalizing behavior problems in adolescence: A longitudinal study

Objective: Clinical studies of asthmatic children have found an association between lung disease and internalizing behavior problems. The causal direction of this association is, however, unclear. This article examines the nature of the relationship between behavior and asthma problems in childhood and adolescence. Methods: Data were analyzed on 5135 children from the Mater University Study of Pregnancy and its outcomes (MUSP), a large birth cohort of mothers and children started in Brisbane, Australia, in 1981. Lung disease was measured from maternal reports of asthma/bronchitis when the children were aged 5 and maternal reports of asthma symptoms when the children were aged 14. Symptoms of internalizing behaviors were obtained by maternal reports (Child Behavior Checklist) at 5 years and by maternal and children's reports at 14 years (Child Behavior Checklist and Youth Self Report). Results: Although there was no association between prevalence of asthma and externalizing symptoms, asthma and internalizing symptoms were significantly associated in cross-sectional analyses at 5 and 14 years. In prospective analyses, after excluding children with asthma at 5 years, internalizing symptoms at age 5 were not associated with the development of asthma symptoms at age 14. After excluding children with internalizing symptoms at 5 years, those who had asthma at 5 years had greater odds of developing internalizing symptoms at age 14. Conclusion: Children who have asthma/bronchitis by the age of 5 are at greater risk of having internalizing behavior problems in adolescence.

Alcohol use and risk taking among regular ecstasy users

We examine alcohol use in conjunction with ecstasy use and risk-taking behaviors among regular ecstasy users in every capital city in Australia. Data on drug use and risks were collected in 2004 from a national sample of 852 regular ecstasy users (persons who had used ecstasy at least monthly in the preceding 6 months). Users were grouped according to their typical alcohol use when using ecstasy: no use, consumption of between one and five standard drinks, and consumption of more than five drinks (binge alcohol use). The sample was young, well educated, and mainly working or studying. Approximately two thirds (65%) of the regular ecstasy users reported drinking alcohol when taking ecstasy. Of these, 69% reported usually consuming more than five standard drinks. Those who did not drink alcohol were more disadvantaged, with greater levels of unemployment, less education, higher rates of drug user treatment, and prison history. They were also more likely than those who drank alcohol when using ecstasy to be drug injectors and to be hepatitis C positive. Excluding alcohol, drug use patterns were similar between groups, although the no alcohol group used cannabis and methamphetamine more frequently. Binge drinkers were more likely to report having had three or more sexual partners in the past 6 months and were less likely to report having safe sex with casual partners while under the influence of drugs. Despite some evidence that the no alcohol group were more entrenched drug users, those who typically drank alcohol when taking ecstasy were as likely to report risks and problems associated with their drug use. It appears that regular ecstasy users who binge drink are placing themselves at increased sexual risk when under the influence of drugs. Safe sex messages should address the sexual risk associated with substance use and should be tailored to reducing alcohol consumption, particularly targeting heavy alcohol users. The study's limitations are noted.

Does anticipation training affect drivers' risk taking?

Skill and risk taking are argued to be independent and to require different remedial programs. However, it is possible to contend that skill-based training could be associated with an increase, a decrease, or no change in fisk-taking behavior. In 3 experiments, the authors examined the influence of a skill-based training program (hazard perception) on the fisk-taking behavior of car drivers (using video-based driving simulations). Experiment 1 demonstrated a decrease in risk taking for novice drivers. In Experiment 2, the authors examined the possibilities that the skills training might operate through either a nonspecific reduction in risk taking or a specific improvement in hazard perception. Evidence supported the latter. These findings were replicated in a more ecological context in Experiment 3, which compared advanced and nonadvanced police drivers.

Risk taking from the participant's perspective: The case of driving and accident risk

Although perceived health risk plays a prominent role in theories of health behavior. its empirical role in risk taking is less clear. In Study 1 (N = 129), 2 measures of drivers' risk-taking behavior were found to be unrelated to self-estimates of accident concern but to be related to self-ratings of driving skill and the perceived thrill of driving. In Study 2 (N = 405), out of a wide range of potential influences, accident concern had the weakest relationship with risk taking. The authors concluded that although health risk is a key feature in many theories of health behavior and a central focus for researchers and policy makers, it may not be such a prominent factor for those actually taking the risk.

Risk -taking propensity of faculty, administrators, and academic department heads at a large, urban, multi -campus community college

This research was undertaken to explore dimensions of the risk construct, identify factors related to risk-taking in education, and study risk propensity among employees at a community college. Risk-taking propensity (RTP) was measured by the 12-item BCDQ, which consisted of personal and professional risk-related situations balanced for the money, reputation, and satisfaction dimensions of the risk construct. Scoring ranged from 1.00 (most cautious) to 6.00 (most risky).^ Surveys including the BCDQ and seven demographic questions relating to age, gender, professional status, length of service, academic discipline, highest degree, and campus location were sent to faculty, administrators, and academic department heads. A total of 325 surveys were returned, resulting in a 66.7% response rate. Subjects were relatively homogeneous for age, length of service, and highest degree.^ Subjects were also homogeneous for risk-taking propensity: no substantive differences in RTP scores were noted within and among demographic groups, with the possible exception of academic discipline. The mean RTP score for all subjects was 3.77, for faculty was 3.76, for administrators was 3.83, and for department heads was 3.64.^ The relationship between propensity to take personal risks and propensity to take professional risks was tested by computing Pearson r correlation coefficients. The relationships for the total sample, faculty, and administrator groups were statistically significant, but of limited practical significance. Subjects were placed into risk categories by dividing the response scale into thirds. A 3 x 3 factorial ANOVA revealed no interaction effects between professional status and risk category with regard to RTP score. A discriminant analysis showed that a seven-factor model was not effective in predicting risk category.^ The homogeneity of the study sample and the effect of a risk-encouraging environment were discussed in the context of the community college. Since very little data on risk-taking in education is available, risk propensity data from this study could serve as a basis for comparison to future research. Results could be used by institutions to plan professional development activities, designed to increase risk-taking and encourage active acceptance of change. ^

Academic Risk-Taking in Higher Education

Little is known about how adults learn to take risks. However, learning to take risks can be beneficial to adults who fear uncertainty or struggle with academic achievement. Higher education can play a leading role in embracing risk-taking and raising the interest level of adult learners through strategic learning activities.

Experimentally Testing the Effect of Parent-Adolescent Conflict on HIV Risk, and Investigation of a Neurobiological Moderator of This Effect

Human immunodeficiency virus (HIV) is a condition in which immune cells become destroyed such that the body may become unable to fight off infections. Engaging in risk-taking behaviors (e.g., substance use) puts people at heightened risk for HIV infection, with mid-to-late adolescents at increasing risk (Leigh & Stall, 1993). Environmental and neurological reasons have been suggested for increased risk-taking among adolescents. First, family-level precursors such as parent-adolescent conflict have been significantly associated with and may pose risk for engaging in substance use and risk-taking (Duncan, Duncan, Biglan, & Ary, 1998). Thus, parent-adolescent conflict may be an important proximal influence on HIV risk behaviors (Lester et al., 2010; Rowe, Wang, Greenbaum, & Liddle, 2008). Yet, the temporal relation between parent-adolescent conflict and adolescent HIV risk-taking behaviors is still unknown. Second, at-risk adolescents may carry a neurobiological predisposition for engaging in trait-like expressions of disinhibited behavior and other risk-taking behaviors (Iacono, Malone, & McGue, 2008). When exposed to interpersonally stressful situations, their likelihood of engagement in HIV risk behaviors may increase. To investigate the role of parent-adolescent conflict in adolescent HIV risk-taking behaviors, 49 adolescents ages 14-17 and their parent were randomly assigned to complete a standardized discussion task to discuss a control topic or a conflict topic. Immediately after the discussion, adolescents completed a laboratory risk-taking measure. In a follow-up visit, eligible adolescents underwent electrophysiological (EEG) recording while completing a task designed to assess the presence of a neurobiological marker for behavioral disinhibition which I hypothesized would moderate the links between conflict and risk-taking. First, findings indicated that during the discussion task, adolescents in the conflict condition evidenced a significantly greater psychophysiological stress response relative to adolescents in the control condition. Second, a neurobiological marker of behavioral disinhibition moderated the relation between discussion condition and adolescent risk-taking, such that adolescents evidencing relatively high levels of a neurobiological marker related to sensation-seeking evidenced greater levels of risk-taking following the conflict condition, relative to the control condition. Lastly, I observed no significant relation between parent-adolescent conflict, the neurobiological marker of behavioral disinhibition and adolescent engagement in real-world risk-taking behavior.