Limited Relationship Between Echocardiographic Measures and Electrocardiographic Markers of Left Ventricular Size in Healthy Children.

Pediatric ECG standards have been defined without echocardiographic confirmation of normal anatomy. The Pediatric Heart Network Normal Echocardiogram Z-score Project provides a racially diverse group of healthy children with normal echocardiograms. We hypothesized that ECG and echocardiographic measures of left ventricular (LV) dimensions are sufficiently correlated in healthy children to imply a clinically meaningful relationship. This was a secondary analysis of a previously described cohort including 2170 digital ECGs. The relationship between 6 ECG measures associated with LV size were analyzed with LV Mass (LVMass-z) and left ventricular end-diastolic volume (LVEDV-z) along with 11 additional parameters. Pearson or Spearman correlations were calculated for the 78 ECG-echocardiographic pairs with regression analyses assessing the variance in ECG measures explained by variation in LV dimensions and demographic variables. ECG/echocardiographic measurement correlations were significant and concordant in 41/78 (53%), though many were significant and discordant (13/78). Of the 6 ECG parameters, 5 correlated in the clinically predicted direction for LV Mass-z and LVEDV-z. Even when statistically significant, correlations were weak (0.05-0.24). R2 was higher for demographic variables than for echocardiographic measures or body surface area in all pairs, but remained weak (R2 ≤ 0.17). In a large cohort of healthy children, there was a positive association between echocardiographic measures of LV size and ECG measures of LVH. These correlations were weak and dependent on factors other than echocardiographic or patient derived variables. Thus, our data support deemphasizing the use of solitary, traditional measurement-based ECG markers traditionally thought to be characteristic of LVH as standalone indications for further cardiac evaluation of LVH in children and adolescents.

Establishing Levels of Personality Functioning Using the Structured Interview of Personality Organization (STIPO-R): a Latent Profile Analysis.

Both the new ICD-11 and the latest Alternative DSM-5 Model for Personality Disorders focus on self and interpersonal functioning as the central feature of personality pathology, also acknowledging that personality disorders are organized along a dimensional continuum of severity. This revised understanding is in line with long-standing psychodynamic conceptualisations of personality pathology, in particular Kernberg's object relations model of personality organization. Despite existing evidence for the clinical utility of the derived Structured Interview of Personality Organization (STIPO-R), empirical support for the identification of clear cut-points between the different levels of personality functioning is missing. For this purpose, a total of 764 adult participants were recruited across two clinical (outpatient and inpatient) settings (n = 250) and two non-clinical (university students and general community) samples (n = 514). Results from the mixture modeling suggested the existence of five groups across the clinical and non-clinical samples that covered: healthy personality functioning, maladaptive personality rigidity, and mild, moderate, and severe levels of personality pathology. All five indicators of personality organization were found to be reliable predictors of personality pathology. Of the five STIPO-R indicators, Aggression and Moral Values had the most discriminative power for differentiating between the Mild, Moderate, and Severe personality disorder groups. Implications of these findings are discussed.

Contributions of Multimethod Personality Assessment in Indirect Evaluation.

Indirect assessment is a useful tool in forensic evaluation, especially in cases of threat assessment. To this end, we illustrated the ability to conceptualize a complicated case (i.e., Theodore John Kaczynski) using an indirect approach, with a particular emphasis upon dimensional frameworks of personality. Raters who were unrelated to Mr. Kaczynski's case and with expertise in relevant domains were asked to study information available in the public domain about Mr. Kaczynski and provide ratings using several assessment instruments. Our aim was not to provide a professional clinical opinion, but rather engage in scholarly discourse about the utility of instruments. Mr. Kaczynski was rated to demonstrate characteristics associated with lone actor terrorists. He showed an elevation on a measure of psychosis, and raters conceptualized trauma as an important aspect of his functioning. He demonstrated impairments in detachment and psychoticism (Criterion B of the AMPD) and interpersonal functioning (Criterion A of the AMPD). Clinical conceptualizations for Mr. Kaczynski emphasized schizotypal and paranoid personality disorders. This analysis of an infamous case about which considerable data are publicly available demonstrates the ease with which indirect and multimethod assessment can be applied and integrated in forensic assessment, using modern conceptualizations of personality pathology.

Effortful control is associated with executive attention: A computational study.

INTRODUCTION: Effortful control (EC) is the self-regulatory aspect of temperament that is thought to reflect the efficiency of executive attention (EA). Findings on relationship between EC and performance on EA tasks among adults are still contradictory. This study used a computational approach to clarify whether greater self-reported EC reflects better EA. METHODS: Four hundred twenty-seven healthy subjects completed the Adult Temperament Questionnaires and the Attention Network Task-revised, a conflict resolution task that gauges EA as the flanker effect (FE), that is, the difference in performances between incongruent and congruent trials. Here we also employed a drift-diffusion model in which parameters reflecting the actual decisional process (drift rate) and the extra-decisional time are extracted for congruent and incongruent trials. RESULTS: EC was not correlated with the FE computed with the classic approach, but correlated positively with drift rate for the incongruent trials, even when controlling for the drift rate in the congruent condition and the extra-decisional time in the incongruent condition. CONCLUSION: This study demonstrates an association between self-reported EC and EA among adults. Specifically, EC is not associated with overall response facilitation but specifically with a greater ability to make goal-oriented decisions when facing conflicting information.

Examining the Interpersonal Profiles and Nomological Network Associated with Narcissistic Grandiosity and Narcissistic Vulnerability.

Theory and research have consistently shown that pathological narcissism can best be described by 2 phenotypic expressions, narcissistic grandiosity and narcissistic vulnerability. The current study sought to examine the specific types of interpersonal problems reported by those high in narcissistic grandiosity and high in narcissistic vulnerability as well as examine the nomological network associated with these 2 manifestations of narcissism. In a sample of university students who completed self-report measures of pathological narcissism, interpersonal problems, depression, self-esteem, malignant self-regard, self-defeating personality disorder symptoms, and anger, we found that narcissistic grandiosity (n = 108) was associated with one distinct interpersonal profile, for example, being overly intrusive in relationships with others, while narcissistic vulnerability (n = 88) was associated with a wider range of interpersonal problems on the interpersonal circumplex. Using cluster analysis, we found 3 interpersonal subtypes associated with narcissistic vulnerability, an intrusive subtype, a cold subtype, and a socially avoidant subtype. Further examination of group differences showed that the 3 interpersonal subtypes associated with narcissistic vulnerability could also be distinguished based on their experience and expression of anger. This suggests the importance of assessing profiles of interpersonal functioning and anger in narcissistic vulnerability. The clinical implications of our results are discussed.

Importance of Self and Other in Defining Personality Pathology.

Criteria A of the DSM-5 Alternative Model for Personality Disorders (AMPD) defines personality pathology in terms of impairments in "self" (identity, self-direction) and "interpersonal" (empathy, intimacy) functioning. Articulated as a set of dynamic regulatory and relational processes that are stratified in the Level of Personality Functioning Scale, these impairments involve how individuals think and feel about themselves and others and how they relate to others. Defining personality pathology in terms of regulatory and relational processes involving self and other, and distinguishing severity of personality pathology from individual differences in its expression (Criteria B), offers the AMPD several advantages. First, it distinguishes the nature and severity of personality pathology from other forms of psychopathology. Second, it allows the AMPD to integrate personality structure and personality processes. Third, it is highly suitable for synthesis with the Contemporary Integrative Interpersonal Theory of personality. Finally, beyond the interpersonal perspective, it facilitates even broader theoretical and treatment integration.

Comparison of the Medtronic SelectSecure and conventional pacing leads: Long-term follow-up in a multicenter pediatric and congenital cohort.

INTRODUCTION: The Medtronic SelectSecure™ (Minneapolis, MN, USA) pacing lead (SS) has theoretical advantages compared to conventional (C) transvenous pacing leads (PLs). The study purpose was to determine whether differences in electrical function and lead survival exist between these PLs in a large data set of pediatric and congenital patients. METHODS: A multicenter historical longitudinal cohort study was performed comparing SS and CPL performance over a 72-month follow-up (FU). Ten centers provided data for both SS and CPL, matched for age, implanted pacing chamber, time period of implantation, and presence of heart disease. RESULTS: The cohort consisted of 141 subjects in each group. No statistical differences were observed in age, gender, presence of heart disease, or pacing indication. Atrial and ventricular capture thresholds were stable throughout FU and higher in the SS group (atrial: 0.75 ± 0.02 vs 0.5 ± 0.04 V, ventricular: 1.0 ± 0.04 vs 0.75 ± 0.04 V), P < 0.001. Group PL sensing thresholds did not differ. The SS group required greater energy to pace (atrial: 0.57 ± 0.05 vs 0.32 ± 0.02 mJ, ventricular: 0.83 ± 0.05 vs 0.56 ± 0.06 mJ), P = 0.001. Early lead dislodgement and phrenic nerve stimulation were greater in the SS group (P = 0.03). Long-term lead survival was high and similar between the two groups, P = 0.35. CONCLUSIONS: Long-term survival of both PL was high with a low fracture rate. The SS had excellent electrical function but did show higher capture thresholds and increased energy to pace; these differences are offset by other advantages of the SS PL.

Effortful Control and Interpersonal Behavior in Daily Life.

The Cognitive-Affective Processing System (CAPS) was used to examine effortful control (EC) as a moderator of daily interpersonal behavior. Participants (N = 240) were nonclinical young adults who completed a 7-day event-contingent experience sampling study of interpersonal perception and affect. Multilevel linear models indicated that EC moderated within-person covariation of interpersonal warmth and affect activation; high EC individuals reported greater momentary warm behaviors when perceiving others as affectively activated. EC also amplified between-person covariation of interpersonal warmth between self and others; high EC individuals generally responded to perceptions of another's warmth with a greater degree of warm behavior. Varying levels of EC predict responses to interpersonal perceptions and affect in daily life, suggesting an important dimension for interpersonal functioning.

Malignant Narcissism in Relation to Clinical Change in Borderline Personality Disorder: An Exploratory Study.

BACKGROUND: Normal and pathological narcissism have been the focus of considerable theoretical discussion and empirical research in recent years in personality psychology and psychopathology. Kernberg [1-4] has argued that there is a particularly dysfunctional and impairing variant of narcissistic disturbance known as malignant narcissism. This exploratory study sought to develop, using established assessment methods, a dimensional measure of malignant narcissism that incorporates the key features of grandiose narcissism, paranoid propensities, psychopathic features, and proclivity for a sadistic and aggressive interpersonal style. Method and Sampling: This study examined 57 subjects, diagnosed with borderline personality disorder that were treated using 3 different empirically supported treatments in a previous study [5], for possible deviance on the proposed malignant narcissism index. It also evaluated 2 important clinical domains of change in relation to malignant narcissism. To wit, it was predicted, based on Kernberg's [3, 4] clinical model, that elevated levels of malignant narcissism would be significantly associated with slower rates of improvement in both general psychosocial/psychological functioning and anxiety among treated individuals. RESULTS: Higher levels of malignant narcissism were associated, as predicted, with slower rates of improvement in both global functioning and anxiety. The proposed malignant narcissism index was a more powerful predictor of slowed improvement in global functioning than simple narcissistic personality disorder features. CONCLUSIONS: The heuristic potential of the malignant narcissism construct is discussed and the utility of a dimensional approach to this construct is explored, especially in reference employing personality traits/processes to better understand pathological configurations and personality disturbance.

Personality Constructs and Paradigms in the Alternative DSM-5 Model of Personality Disorder.

The DSM-5 Section III alternative model for personality disorders (AMPD) is a personality disorder (PD) nosology based on severity of personality dysfunction and pathological traits. We examined the degree to which the personality constructs identified by McAdams and Pals (2006; dispositional traits, characteristic adaptations, narrative identity) and the paradigms of personality assessment described by Wiggins (2003; psychodynamic, interpersonal, personological, multivariate, empirical) are represented within the AMPD. Nine raters expert with the AMPD and personality evaluated elements of Criterion A and the 25 trait facets of Criterion B for presence of type and degree of personality constructs and paradigms, as well as level of inference. Criterion B showed higher rater agreement compared to Criterion A. Criteria A and B reflect different configurations of construct, paradigm, and level of inference. The characteristic adaptation construct and interpersonal paradigm were strongly reflected in both Criteria A and B. The psychodynamic and personological paradigms and the narrative identity construct were highly correlated, and the multivariate, empirical, and dispositional traits variables were highly correlated. Results illustrate differential conceptual emphases as well as areas of overlap with Criteria A and B. This characterization highlights that PD nosology rests on personality theory and suggests implications for integrative PD assessment.

A Multisurface Interpersonal Circumplex Assessment of Rejection Sensitivity.

Individuals high in rejection sensitivity (RS) are at risk for experiencing high levels of interpersonal distress, yet little is known about the interpersonal profiles associated with RS. This investigation examined the interpersonal problems, sensitivities, and values associated with RS in 2 samples: 763 multicultural undergraduate students (Study 1) and 365 community adults (Study 2). In Study 1, high anxious RS was associated with socially avoidant interpersonal problems, whereas low anxious RS was associated with vindictive interpersonal problems. In Study 2, we assessed both anxious and angry expectations of rejection. Circumplex profile analyses showed that the high anxious RS group reported socially avoidant interpersonal problems, sensitivities to remoteness in others, and valuing connections with others, whereas the high angry RS group reported vindictive interpersonal problems, sensitivities to submissiveness in others, and valuing detached interpersonal behavior. Low anxious RS was related to domineering interpersonal problems, sensitivity to attention-seeking behavior, and valuing detached interpersonal behavior, whereas low angry RS was related to submissive interpersonal problems, sensitivity to attention-seeking behavior, and valuing receiving approval from others. Overall, results suggest that there are distinct interpersonal profiles associated with varying levels and types of RS.

Frontolimbic neural circuit changes in emotional processing and inhibitory control associated with clinical improvement following transference-focused psychotherapy in borderline personality disorder.

AIMS: Borderline personality disorder (BPD) is characterized by self-regulation deficits, including impulsivity and affective lability. Transference-focused psychotherapy (TFP) is an evidence-based treatment proven to reduce symptoms across multiple cognitive-emotional domains in BPD. This pilot study aimed to investigate neural activation associated with, and predictive of, clinical improvement in emotional and behavioral regulation in BPD following TFP. METHODS: BPD subjects (n = 10) were scanned pre- and post-TFP treatment using a within-subjects design. A disorder-specific emotional-linguistic go/no-go functional magnetic resonance imaging paradigm was used to probe the interaction between negative emotional processing and inhibitory control. RESULTS: Analyses demonstrated significant treatment-related effects with relative increased dorsal prefrontal (dorsal anterior cingulate, dorsolateral prefrontal, and frontopolar cortices) activation, and relative decreased ventrolateral prefrontal cortex and hippocampal activation following treatment. Clinical improvement in constraint correlated positively with relative increased left dorsal anterior cingulate cortex activation. Clinical improvement in affective lability correlated positively with left posterior-medial orbitofrontal cortex/ventral striatum activation, and negatively with right amygdala/parahippocampal activation. Post-treatment improvements in constraint were predicted by pre-treatment right dorsal anterior cingulate cortex hypoactivation, and pre-treatment left posterior-medial orbitofrontal cortex/ventral striatum hypoactivation predicted improvements in affective lability. CONCLUSIONS: These preliminary findings demonstrate potential TFP-associated alterations in frontolimbic circuitry and begin to identify neural mechanisms associated with a psychodynamically oriented psychotherapy.

Interpersonal functioning in obsessive-compulsive personality disorder.

The core symptoms of obsessive-compulsive personality disorder (OCPD) often lead to interpersonal difficulties. However, little research has explored interpersonal functioning in OCPD. This study examined interpersonal problems, interpersonal sensitivities, empathy, and systemizing, the drive to analyze and derive underlying rules for systems, in a sample of 25 OCPD individuals, 25 individuals with comorbid OCPD and obsessive-compulsive disorder (OCD), and 25 healthy controls. We found that OCPD individuals reported hostile-dominant interpersonal problems and sensitivities with warm-dominant behavior by others, whereas OCPD+OCD individuals reported submissive interpersonal problems and sensitivities with warm-submissive behavior by others. Individuals with OCPD, with and without OCD, reported less empathic perspective taking relative to healthy controls. Finally, we found that OCPD males reported a higher drive to analyze and derive rules for systems than OCPD females. Overall, results suggest that there are interpersonal deficits associated with OCPD and the clinical implications of these deficits are discussed.

Assessing Interpersonal Subtypes in Depression.

The context-free diagnoses outlined by the Diagnostic and Statistical Manual of Mental Disorders might not provide enough information to represent the heterogeneity observed in depressed patients. Interpersonal factors have been linked to depression in a mutually influencing pathoplastic relationship where certain problems, like submissiveness, are related to symptom chronicity. This study evaluated interpersonal pathoplasticity in a range of depressive presentations. We examined archival data collected from 407 participants who met criteria for major depressive disorder (MDD), dysthymic disorder (DD), or subthreshold depression (sD). Latent profile analysis (LPA) identified 5 interpersonal subtypes (vindictive, intrusive, socially avoidant, exploitable, and cold). Apart from gender, the subtypes did not differ significantly on demographic characteristics, psychiatric comorbidity, or self-report depression severity. Socially avoidant participants were more likely to meet criteria for a clinical depression diagnosis (MDD or DD), whereas vindictive participants were more likely to have sD. Our results indicate that interpersonal problems could account for heterogeneity observed in depression.

Analysis of free and bound phenolics in wine and grapes by GC-MS after automated SPE.

The results of validation of a method for the analysis of free and bound phenolics in wine and grapes are presented. Wine and grape extracts are fractionated by automated solid-phase extraction on Bond Elut PPL cartridges to give free and bound phenolic fractions. Bound fractions are subjected to acid hydrolysis, and the phenolics released are recovered by solid-phase extraction on Bond Elut PPL cartridges. The fractions are further purified by automated solid-phase extraction on Bond Elut silica cartridges. After derivatisation to form trimethylsilyl ethers, the phenolics are determined by gas chromatography-mass spectrometry with selected ion monitoring. The method is suitable for robust, high-throughput monitoring of the concentrations of phenolics that can affect the palatability of wine.

Left ventricular myocardial performance index change for detection of acute cellular rejection in pediatric heart transplantation.

EMB, the gold standard for diagnosis of ACR, poses unique risks in children. Limited cross-sectional data have associated LV MPI with ACR. We hypothesize that a relative change in MPI from baseline without ACR to the time of ACR will better detect ACR than an absolute threshold LV MPI value. We identified 40 children with ACR ≥60 days post-transplant matching them by age and time from transplantation to 40 children without ACR. There was a significant increase in LV MPI at time of ACR vs. baseline (0.59 ± 0.17 vs. 0.41 ± 0.11; p < 0.001). There was no difference in LV MPI between baseline and follow-up (0.41 ± 0.11 vs. 0.42 ± 0.11; p = 0.65). An absolute increase in LV MPI of ≥0.47 had 82.5% sensitivity and 85% specificity for ACR, whereas an increase in LV MPI from baseline of ≥20.4% was 90% sensitive and 100% specific. Serial measurement of LV MPI appears to be a sensitive and specific marker of ACR. LV MPI shows good interobserver agreement and increases at the time of EMB-proven ACR with subsequent resolution to baseline measurements upon EMB-proven resolution of ACR. Future studies in larger, prospective cohorts should be undertaken to validate these findings.

The relationship between effortful control, current psychopathology and interpersonal difficulties in adulthood.

This study examined whether the relationship between low effortful control (EC), general psychopathology and interpersonal maladjustment previously reported among children extends to adulthood. Two hundred and forty undergraduate students were assessed using the EC scale of the Adult Temperament Questionnaire, the General Severity Index of the Brief Symptom Inventory (BSI-GSI) and the interpersonal distress index of the Inventory of Interpersonal Problems-Short Circumplex (IIP-distress). Both the BSI-GSI and the IIP-distress scores were related to low levels of EC. Furthermore, interpersonal distress mediated the association between low EC and greater psychopathology severity. These results suggest that deficits in regulatory temperament among adults may be associated with experiencing greater psychopathology distress, and that this relationship may be explained by an impairment in interpersonal adjustment. Such preliminary findings may constitute a useful starting point for investigating this hypothesis among clinical populations.

Assessing interpersonal profiles associated with varying levels of effortful control.

Research has linked individual differences in effortful control (EC) with variations in interpersonal functioning in children and adolescents. Using the Inventory of Interpersonal Problems-Short Circumplex (Hopwood, Pincus, DeMoor, & Koonce, 2008), this study investigated interpersonal problem profiles associated with EC in 763 nonclinical young adults. We found that individuals with low EC reported intrusive interpersonal problems and high levels of interpersonal distress, whereas individuals with high EC reported cold interpersonal problems but low levels of interpersonal distress. Results suggest that EC might play an important role in shaping interpersonal functioning.

The impact of pathological narcissism on psychotherapy utilization, initial symptom severity, and early-treatment symptom change: a naturalistic investigation.

The impact of pathological narcissism on psychotherapy has seldom been investigated empirically, despite extensive clinical theory proposing that highly narcissistic individuals should be reluctant to engage in treatment and derive smaller benefits from therapy. In this study, we investigate the relationship between scores on the Pathological Narcissism Inventory (PNI; Pincus et al., 2009), which assesses both narcissistic grandiosity and narcissistic vulnerability, and clinical variables in a sample of outpatients (N=60) at a community mental health center. Results indicated that grandiosity, but not vulnerability, was negatively related to the use of adjunctive services and positively predicted client-initiated termination of psychotherapy. In addition, grandiosity and vulnerability were related to initial levels of different symptoms in multilevel models using a subsample (n=41) but not generally related to the linear rate of symptom change in early psychotherapy. The results highlight the clinical utility of assessing pathological narcissism in a real-world psychotherapeutic context.

Evaluating Change in Transference, Interpersonal Functioning, and Trust Processes in the Treatment of Borderline Personality Disorder: A Single-Case Study Using Ecological Momentary Assessment.

Transference-focused psychotherapy (TFP) is an empirically supported treatment for borderline personality disorder (BPD) that improves functioning via targeting representations of self affectively relating to others, particularly as evoked in the therapeutic relationship. If change in TFP operates as theorized, then shifts in patterns of "self affectively relating to others" should be observed in the transference prior to shifts in daily relationships. Using ecological momentary assessment (EMA), a patient with BPD rated daily interpersonal events for 2-week periods during 18 months of TFP; at 9 and 18 months these ratings included interactions with the therapist. Results suggest that positive perceptions of her therapist that ran counter to her negatively biased perception in other relationships preceded changes in her perceptions of others. EMA shifts corresponded to improvements in self-reported symptoms, interview-based personality functioning, and therapist assessments. Implications for assimilation of a trusting experience with the therapist as a mechanism of change in TFP are discussed.