Pimavanserin use in a movement disorders clinic: a single-center experience.

BACKGROUND: Parkinson's disease psychosis (PDP) is a disabling non-motor symptom of Parkinson's disease (PD) that is challenging to treat. Dopamine receptor blockers (DRB) are used to treat PDP, though these may be associated with adverse effects, including worsening of Parkinsonism. Pimavanserin, a selective 5-HT2A receptor inverse agonist, was recently FDA-approved for treatment of PDP; however, there is limited information on its long-term use in PDP patients. METHODS: A retrospective chart review of patients prescribed pimavanserin was performed in August, 2017. Data on demographics, psychotic features, sleep, and adverse effects was collected using a semi-structured telephone interview with patients or caregivers. Hallucination severity (HS) was quantified as mild (< 1 episode/week), moderate (1/week to < 1/day), or severe (daily/continuous). RESULTS: Seventeen patients consented to participate in the study; 16 were diagnosed with PDP, 1 with Lewy body dementia. Fourteen had co-morbid cognitive impairment/dementia. The mean duration of Parkinsonism was 11.8 ± 8.0 years, with 2.6 ± 1.9 years of psychosis. Eleven of the seventeen patients reported improvement of hallucinations of which 5/8 were initiated on pimavanserin monotherapy, and 6/9 reported improvement of HS with combination of DRB. Six of nine patients prescribed DRB were able to discontinue this medication after introduction of pimavanserin. Four patients discontinued medications (2, no benefit; 1, spontaneous resolution; 1, cost). No major side effects were reported, and two patients noted subjective improvement of sleep. CONCLUSION: In our series based on a small sample size, pimavanserin is well-tolerated and effective as both monotherapy and adjuvant treatment for moderate to severe. This medication can facilitate reduction or cessation of DRB medication.

The Complex Trauma Inventory: A Self-Report Measure of Posttraumatic Stress Disorder and Complex Posttraumatic Stress Disorder.

The work group revising the criteria for trauma-related disorders in the International Classification of Diseases (ICD-11) made several changes. Specifically, they simplified the criteria for posttraumatic stress disorder (PTSD) and added a new trauma disorder called complex PTSD (CPTSD). These proposed changes to taxonomy require new instruments to assess these novel constructs. We developed a measure of PTSD and CPTSD (the Complex Trauma Inventory; CTI) according to the proposed domains, creating several items to assess each domain. We examined the factor structure of the CTI in two separate samples of diverse college students (n1 = 391; n2 = 391) who reported exposure to at least one traumatic event and at least occasional functional impairment. After reducing the original 50 items in the item pool to 20 items, confirmatory factor analyses supported two highly correlated second-order factors-PTSD and disturbances in self-organization (DSO)-with PTSD (i.e., reexperiencing, avoidance, sense of threat) and DSO (i.e., affect dysregulation, negative self-concept, and disturbances in relationships), each loading on three of the six ICD-11-consistent first-order factors, root mean square error of approximation (RMSEA) = .056, 95% confidence interval (CI) [.048, .064], comparative fit index (CFI) = .956, Tucker-Lewis index (TLI) = .948, standardized root mean square residual (SRMR) = .043, Bayesian information criterion (BIC) = 641.55, χ2 (163) = 361.02, p < .001. Internal consistencies for PTSD and DSO were good to excellent (Cronbach's αs = .89 to .92). Supplementary analyses supported the gender invariance of the CFA model, as well as convergent and discriminant validity of the CTI. The validity of the CTI supports the distinction between CPTSD and PTSD. Moreover, the CTI will assist clinicians with diagnosis, symptom tracking, treatment planning, and assessing outcomes.

Attachment and Family Processes in Children's Psychological Adjustment in Middle Childhood.

This study examined the links between parent-child attachment, whole family interaction patterns, and child emotional adjustment and adaptability in a sample of 86 community families with children between the ages of 8 and 11 years. Family interactions were observed and coded with the System for Coding Interactions and Family Functioning (SCIFF; Lindahl, 2001). Both parents and each target child completed the appropriate form of the Behavior Assessment System for Children-2nd Edition (BASC-2; Reynolds & Kamphaus, 2004). Target children also completed the Children's Coping Strategies Questionnaire (CCSQ; Yunger, Corby, & Perry, 2005). Hierarchical multiple regressions indicated that Secure mother-child attachment was a robust predictor of children's emotional symptoms, but father-child attachment strategies were not significant independent predictors. Positive Affect in family interactions significantly increased the amount of variance accounted for in children's emotional symptoms. In addition, Family Cohesion and Positive Affect moderated the relationship between father-child attachment and children's emotional symptoms. When data from all BASC-2 informants (mother, father, child) were considered simultaneously and multidimensional constructs were modeled, mother-child security directly predicted children's adjustment and adaptive skills, but the influence of father-child security was fully mediated through positive family functioning. Results of the current study support the utility of considering dyadic attachment and family interaction patterns conjointly when conceptualizing and fostering positive emotional and behavioral outcomes in children.

The roles of shame and poor self-concept in explaining low social connection among adult survivors of childhood emotional maltreatment.

Emotional maltreatment (EM) is the most common retrospectively self-reported form of child abuse/neglect. One potential negative outcome for EM survivors is a lack of social connection (SC; i.e., feeling interpersonally distant from others, socially uncomfortable, etc.). Explanations of the link between EM and low SC, however, are insufficiently tested. Theory and empirical work point to shame as a ubiquitous consequence of EM that negatively affects self-concept and is also associated with low SC in adulthood. OBJECTIVE: We test the hypothesis that experiences of EM lead to shame that impairs the development of social self-concept and, ultimately, one's sense of SC. PARTICIPANTS AND SETTING: We collected self-report data from 244 American college students. METHOD: Using structural equation modeling, we tested shame and social self-concept as sequential mediators of the path from EM to SC. RESULTS: Shame and social self-concept mediated the relationship between EM and SC, bringing this direct path below significance. Social self-concept partially mediated shame and SC. Overall, our model accounted for 77% of the variability in SC. CONCLUSIONS: Children subjected to EM by caregivers are likely to experience themselves as deeply flawed (i.e., shame) and have difficulty developing a secure sense of themselves, especially as relational beings. Our results suggest that when shame interferes with the development of a positive social self-concept, survivors of EM are at-risk for low SC. Treatment implications include a focus on healing shame and building social self-concept. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Perceived Psychological Control Relates to Coping-related Drinking Motives via Social Anxiety Among Adolescents: A Cross-sectional Mediation Analysis.

OBJECTIVE: Accumulating evidence suggests that particular parenting behaviors (e.g., elevated psychological control) may increase risk for both problematic social anxiety and alcohol use among youth; however, no work has yet examined these factors together in a single model. Building developmentally-sensitive models of problematic alcohol use trajectories is key to developing effective prevention and intervention strategies. METHOD: The present study includes 94 adolescents (ages 14-17 years; 53.3% girls; 89.2% White) entering a treatment facility for a variety of internalizing and externalizing forms of psychological distress. Levels of perceived parental psychological control, social anxiety, and coping-related drinking motives were assessed. RESULTS: Higher levels of perceived psychological control was associated with a greater endorsement of coping-related drinking motives; however, a significant proportion of that association was accounted for by elevated social anxiety symptoms. CONCLUSIONS: These data extend the existing literature and lay groundwork for more sophisticated experimental and longitudinal designs to corroborate the findings. Moreover, personality-targeted drinking interventions for adolescents may benefit from identifying elevated perceived psychological control as a developmentally relevant risk-factor for social anxiety and problematic drinking motives and administering relevant interventions (e.g., personality-targeted coping skills training, parent-involved care) before drinking patterns are established.

Adjuvant medical therapy in cervical dystonia after deep brain stimulation: A retrospective analysis.

Background: There is limited information on optimization of symptomatic management of cervical dystonia (CD) after implantation of pallidal deep brain stimulation (DBS). Objectives: To describe the long-term, "real-world" management of CD patients after DBS implantation and the role of reintroduction of pharmacologic and botulinum toxin (BoNT) therapy. Methods: A retrospective analysis of patients with focal cervical or segmental craniocervical dystonia implanted with DBS was conducted. Results: Nine patients were identified with a mean follow-up of 41.7 ± 15.7 months. All patients continued adjuvant oral medication(s) to optimize symptom control post-operatively. Three stopped BoNT and four reduced BoNT dose by an average of 22%. All patients remained on at least one medication used to treat dystonia post-operatively. Conclusion: Optimal symptom control was achieved with DBS combined with either BoNT and/or medication. We suggest utilization of adjuvant therapies such as BoNT and/or medications if DBS monotherapy does not achieve optimal symptom control.

From childhood emotional maltreatment to depressive symptoms in adulthood: The roles of self-compassion and shame.

BACKGROUND: Emotional abuse is a form of maltreatment that most strongly predicts adult depressive symptoms in community samples. Introject theories suggest that some depressive symptoms stem from survivors having learned to treat themselves the way they were treated by their perpetrators. OBJECTIVE: Malevolent introjects may undermine self-compassion, which may subsequently maintain feelings of shame. Thus, we hypothesized that self-compassion and shame would mediate the path from retrospective reports of maltreatment to concurrent depressive symptoms in adulthood. PARTICIPANTS AND SETTING: Participants were 244 adult community members and college students living in a Southwestern American metroplex. METHOD: We ran a multiple mediator path model with emotional abuse as the independent variable. We specified four covariates: physical abuse, sexual abuse, physical neglect, and emotional neglect, and held constant the variance they explained in self-compassion, shame, and depression. RESULTS: Our final model accounted for 53.1% of the variance in adult depressive symptoms. A significant indirect effect from emotional abuse passed through both mediators and ended in adult depressive symptoms. We also found an indirect path from emotional neglect to depression passing through both mediators. CONCLUSIONS: It appears emotional abuse and emotional neglect can undermine the formation of self-compassion. Low self-compassion predicts greater shame and depressive symptoms. Our model suggests self-compassion may be a particularly effective intervention point for survivors of emotional maltreatment.

Sensorimotor Integration and GABA-ergic Activity in Embouchure Dystonia: An Assessment with Magnetoencephalography.

Background: Embouchure dystonia (ED) is a task-specific dystonia affecting musicians thought to be related to alteration in sensorimotor processing and loss of cortical inhibition. Case Report: Magnetoencephalography-coherence source imaging (MEG-CSI) was used to map connectivity between brain regions by imaging neuronal oscillations that are coherent across the brain in patient with ED at rest and while using the index finger to evoke dystonia normally triggered by playing the flute. Discussion: During rest, there was increased coherence in the bilateral frontal and parietal regions that became more focal during dystonia. Diffuse hyperexcitability and increased coherence persisted in bilateral parietal regions as well as the bilateral frontal regions.

The Effect of Botulinum Toxin on Network Connectivity in Cervical Dystonia: Lessons from Magnetoencephalography.

Background: Pharmacological management of cervical dystonia (CD) is considered to be symptomatic in effect, rather than targeting the underlying pathophysiology of the disease. Magnetoencephalography (MEG), a direct measure of neuronal activity, while accepted as a modality for pre-surgical mapping in epilepsy, has never been used to explore the effect of pharmacotherapy in movement disorders. Methods: Resting state MEG data were collected from patients with CD, pre- and post-botulinum toxin injections. All of these patients exhibited good clinical benefit with botulinum toxin. Resting state MEG data from four age- and gender-matched healthy controls with no neurological disorders were also collected. Results: Our exploratory study reveals a difference in coherence between controls and patients in the following regions: fronto-striatal, occipito-striatal, parieto-striatal, and striato-temporal networks. In these regions there is an increase after botulinum toxin. Specifically, increased coherence in the left putamen and right superior parietal gyrus was noticeable. Both intrahemispheric and interhemispheric networks were affected. Discussion: This is the first attempt to directly assess changes in functional connectivity with pharmacotherapy using MEG. Botulinum toxin might affect sensorimotor integration, leading to clinical benefit. The presence of increased interhemispheric coherence and intrahemispheric coherence points to the importance of global and local networks in the pathophysiology of dystonia.

Intraoperative MRI for deep brain stimulation lead placement in Parkinson's disease: 1 year motor and neuropsychological outcomes.

Traditional deep brain stimulation requires intraoperative neurophysiological confirmation of electrode placement. Recently, purely image guided methods are being evaluated as to their clinical efficacy in comparison to surgery using microelectrode recordings. We used the ClearPoint(®) system to place electrodes in both the subthalamic nucleus and globus pallidus internus in patients with advanced Parkinson's disease. Off medication UPDRS scores were assessed before and 1 year after surgery as well as pre- and 1 year post-operative neuropsychological outcomes. Targeting precision was also assessed. Patients implanted in the subthalamic nucleus improved by 46.2 % in their UPDRS scores post-operatively (p = 0.03) whereas the globus pallidus group improved by 41 % (p = 0.06). There were no significant adverse neuropsychological outcomes in either group of patients. Mean radial error for the STN group was 1.2 ± 0.7 mm and for the GPi group 0.8 mm ± 0.3 mm. Image guided DBS using the ClearPoint(®)system has high targeting precision with robust clinical outcomes. Our data are in accord with recent studies using the same or similar technologies and provide a rationale for a large comparative study of image-guided versus microelectrode guided DBS.

Grandparents raising their grandchildren: a review of the literature and suggestions for practice.

An increasingly prevalent family constellation is a home headed by a grandparent who is raising grandchildren. We explore the state of our knowledge about such grandparents with particular attention to its implications for service providers and researchers. In our review we address several key areas: (a) the costs and benefits of raising a grandchild; (b) the heterogeneity of custodial grandparent caregivers; (c) the critical need for social support among custodial grandparents; (d) parenting practices and attitudes among grandparents raising grandchildren; and (e) helping efforts at multiple levels with custodial grandparents. We also discuss directions for research and practice concerning custodial grandparents.

Body image, eating behaviors, and attitudes toward exercise among gay and straight men.

Gay men tend to be more dissatisfied with their bodies and may be at greater risk for symptoms of eating disorders compared to heterosexual men. However, the majority of research conducted with gay and heterosexual men has implemented instruments designed to assess eating disorder symptomatology in women. The present study assessed differences between gay and heterosexual men using the Male Eating Behavior and Body Image Evaluation (MEBBIE), an instrument designed to assess attitudes and behaviors related to eating, exercise and body image specifically in men. Analyses of MEBBIE scale means with body mass index (BMI) as the covariate indicated that, relative to their heterosexual counterparts, gay men diet more, are more fearful of becoming fat, and are more dissatisfied with their bodies in general as well as with their degree of muscularity. Gay men were also more likely than heterosexual men to hold distorted cognitions about the importance of having an ideal physique. Contrary to hypotheses, however, gay and straight men did not differ in the degree to which they exercised or felt guilty about missing a workout. Results are discussed in light of previous findings, and implications for clinical practice and future research are considered.

Self-concept in Mexican American girls and boys: validating the Self-Description Questionnaire-I.

This study examined the factor structure and psychometric properties of the Self-Description Questionnaire-I (SDQ-I) in a sample of Mexican American children. Findings provide support for both the classic multidimensional and hierarchical SDQ factor structure and a nonhierarchical model that incorporates a dimension not included in the classic model (i.e., General-Self, a global measure of self-concept). Results of a multiple-group confirmatory factor analysis demonstrate the nonhierarchical model's overall invariance across gender. Gender differences were found, however, on mean SDQ-I subscale scores: Boys reported higher self-concept than girls on the Physical Abilities and Physical Appearance subscales, but girls had higher self-concept than boys on the Reading subscale.

The modified integrative weaning index as a predictor of extubation failure.

INTRODUCTION: The extubation period is one of the most challenging aspects for intensive care teams. Timely recognition of the return to spontaneous ventilation is essential for reducing costs, morbidity, and mortality. Several weaning predictors were studied in an attempt to evaluate the outcome of removing ventilatory support. The purpose of this study was to analyze the predictive performance of the modified integrative weaning index (IWI) in the extubation process. METHODS: A prospective study was performed in an ICU in a public hospital in Porto Alegre, Brazil, with 59 adult medical-surgical beds. The final population of the study comprised 153 patients receiving mechanical ventilation for over 48 h who were extubated during the period from February to November 2011. Demographic data and clinical parameters were collected in addition to extubation predictors, including static compliance of the respiratory system, ratio of breathing frequency to tidal volume, tracheal airway-occlusion pressure 0.1 s after the start of inspiratory flow, and modified IWI. RESULTS: Extubation failure was observed in 23 of the subjects (15%). Subjects with greater positive fluid balance, lower hemoglobin levels, and lower levels of bicarbonate presented a higher rate of reintubation. The 3 modified IWI values (the first and 30th minute of the spontaneous breathing trial and the difference between them), as well as the other ventilatory parameters and extubation predictors, displayed poor extubation outcome discrimination accuracy. All indexes presented small areas under the receiver operating characteristic curve, and no accurate cutoff point was identified. CONCLUSIONS: We concluded that modified IWI, similar to other extubation predictors, does not accurately predict extubation failure.

Early respiratory therapy reduces postoperative atelectasis in children undergoing lung resection.

BACKGROUND: Early physiotherapy reduces pulmonary complications after lung resection in adult patients. However, the effectiveness and the techniques used in postoperative physiotherapy in children undergoing lung resection have not been well described. Therefore, the standardization of a physiotherapeutic attendance after lung resection in children is necessary. METHODS: This was a retrospective and prospective, interventional, descriptive, and quantitative study. We evaluated 123 pediatric subjects undergoing lung resection. Fifty-two children were prospectively submitted to a standardized physiotherapy protocol that included a mask with a positive expiratory pressure of 10 cm H2O, expiratory rib cage compression, coughing, lifting the upper limbs, and ambulation, starting within the first 4 hours after surgery and continuing 3 times each day. A historical control group of 71 subjects received physiotherapeutic techniques without specific standardization and with variability in the start date and number of days attended. We recorded the presence of postoperative complications, prolonged air leak, postoperative bronchoscopy, the time of chest tube removal, and hospital stay following surgery. RESULTS: The group that received a standardized protocol of physiotherapy had fewer instances of atelectasis than the control group (15.4% vs 7.6%, P = .01). Subjects in the control group were more likely than those in the intervention group to require fiberoptic bronchoscopy for bronchial toilet (n = 14 [19.7%] vs n = 5 [9.6%], P ≤ .001). There was no difference in the time of drainage or hospital stay between the groups. CONCLUSIONS: Implementation of a standardized physiotherapeutic protocol after lung resection in children decreases atelectasis but does not reduce the time of chest tube removal or the duration of hospital stay.

Men, muscles, and mood: the relationship between self-concept, dysphoria, and body image disturbances.

Beginning in the early 1990s investigations into the body image concerns of men have increased, and this study adds to extant research by examining correlates of more general body dissatisfaction (BD) and symptoms of muscle dysmorphia (MD) in particular. Three hundred four undergraduate men completed a broad-based symptom inventory, a self-concept questionnaire, and an instrument that assessed problematic body image, eating, and exercise patterns as well as specific symptoms of MD. Multiple regression analyses suggest that lower ratings of overall self-concept and higher levels of depression, anxiety, and interpersonal sensitivity are predictive of body image concerns in men. Furthermore, these variables accounted for almost twice the variance in general BD than they did for specific symptoms of MD. In addition, anorexic and bulimic behaviors, obsessive-compulsive symptoms, and risk factors for interpersonal problems were also associated with symptoms of MD, even when BD was controlled.

The role of attachment style in coping with job loss and the empty nest in adulthood.

The current study employed a life events perspective to examine the relationship between attachment style and both adjustment and coping processes in adults during two specific life events involving both the loss of and a renegotiation of an attachment relationship: the launching of children from the family of origin and job loss, which represent both normative and non-normative transitions, respectively. Using median splits for each attachment dimension (closeness, dependency, and anxiety) to define secure, anxious, and avoidant styles, based on the work of Collins and Read, analyses failed to yield a significant multivariate life event by style interaction. However, a statistically significant multivariate main effect for life event and for attachment style was obtained. Additionally, findings suggested that to a certain extent, the impact of attachment style and life events is moderated by gender, wherein a supplemental analysis yielded a significant life event by gender by level of closeness interaction. The data support the notion that securely attached individuals may be more equipped to meet developmental life challenges in adulthood, and extend previous work that is limited to women and to the empty nest.

Gender differences in body esteem among older adults.

Ninety-five adults aged 60-91 completed measures of Body-as-Object Esteem (BOE) (i.e., appearance) and Body-as-Process Esteem (BPE) (i.e., function) to explore gender differences in body esteem among older adults. As hypothesized, a significant age by gender interaction revealed that men become more disparaging of the appearance and function of their bodies in their last decades of life, while women do not. Level of physical disability was negatively correlated with BOE, particularly for disabled women. Furthermore, as is seen across the lifespan, self-esteem is a significant predictor of BOE. Disabled participants who were older than 74 years had disproportionately low BPE scores and similarly poor global self-esteem. Whether working with older adults or studying body esteem in this population, it is vital that both dimensions of body esteem are assessed along with the impact of disability status, gender, self-esteem, and age.

Relationships between grief and family system characteristics: a cross lagged longitudinal analysis.

The present study explored the question of whether the grief process affects the characteristics of relationships within the family system or, alternatively, whether family characteristics affect the experience of grief symptoms. Sixty-one people who had recently experienced the death of a parent (82%) or spouse (18%) completed a questionnaire to assess their current grief symptomatology and characteristics of the relationships within their family 4-5 weeks after the death, and again six months later. Results from cross-lagged panel analyses suggested that increased expression of family affect, family cohesion, and both higher total Family Environment Scale and Family Assessment Measure Version III General scores were predictors of fewer grief symptoms over time. Overall, these results suggest that knowledge of a variety of aspects of a family's structure and process shortly after a death may help predict the later grief of the loss of a loved one.

Hippocampal volume and memory performance in a community-based sample of women with posttraumatic stress disorder secondary to child abuse.

Childhood abuse is linked to posttraumatic stress disorder (PTSD), which follows abuse survivors into adulthood. This study identified the neuropsychological and neuromorphological sequelae of PTSD among prepubescently abused women. Right-handed women aged 20-40 years were placed into PTSD and abuse, abuse only, and normal control groups (n = 17 per group). Participants were screened for trauma history and psychiatric symptoms, demographically matched, and given neuropsychological tests and a magnetic resonance scan of their brain. Women with PTSD did not express significant deficits in memory performance or hippocampal volume when compared with the abuse and normal control groups.