Assessment of stress and self-efficacy for the NIH Toolbox for Neurological and Behavioral Function.

BACKGROUND AND OBJECTIVES: The NIH Toolbox for Neurological and Behavioral Function assessment battery contains measures in the domains of cognitive function, motor function, sensory function, and emotional health. It was designed for use in epidemiological and clinical trials health-related research. DESIGN: This paper describes the first phase of instrument development for the stress and self-efficacy subdomain of emotional health. Based on an extensive literature review and expert consultation, 127 measures were initially considered for inclusion in this subdomain, including measures of stress, self-efficacy, emotion regulation, and coping. RESULTS: Several measures, including emotion regulation and measures of coping strategies, did not meet criteria that were a priori established for inclusion. Psychometric properties of the remaining candidate measures were evaluated using data from five independent samples (combined N = 3175). Confirmatory and exploratory factor analyses indicated the Perceived Stress Scale and the General Self-Efficacy Scale each assessed single dimensions. CONCLUSIONS: Based on their psychometric performance, these two instruments were selected for inclusion and subsequent national norming for the NIH Toolbox.

La regulación emocional y su implicación en la salud del adolescente / Emotion regulation and its implications for the adolescent´s health

En este artículo se realiza una revisión teórica acerca de un tema que ha cobrado mayor auge en las últimas 2 décadas: la regulación emocional. Se enfatizan las importantes consecuencias que una regulación emocional inadecuada puede tener en el ámbito de la salud mental y física. Precisamente, se resalta su papel en determinados problemas vinculados con la salud del adolescente, tales como, la hipertensión arterial y la depresión. Se destacan investigaciones realizadas en el territorio central de Cuba relacionadas con la temática.

This article presented a theoretical review of a topic which has aroused a lot of interest in the last two decades: emotion regulation. Emphasis was made on the important consequences of emotion dysregulation in the field of mental and physical health. The role of certain problems linked to the adolescent´s health such as blood hypertension and depression were underlined together with the research studies on this issue conducted in the central part of the Cuban territory.

I know it when I quantify it: ecological momentary assessment and recurrence quantification analysis of emotion dysregulation in children with ADHD.

Two studies examined the feasibility, utility, and validity of Ecological Momentary Assessment (EMA) and Recurrence Quantification Analysis (RQA) in assessing emotion dysregulation in children with Attention-Deficit/Hyperactivity Disorder (ADHD). In Study 1, 11 parents of children with ADHD ages 8-11 completed EMA-based ratings of their children's mood three times daily for 28 days (84 ratings total) and questionnaires regarding their children's emotion dysregulation. RQA was used to quantify the temporal patterning of dysregulation of the children's mood. In Study 2, five children ages 8-11 completed EMA-based ratings of their mood three times daily for 28 days. Results supported the feasibility and validity of the parent report EMA protocol, with greater intensity, variability, and persistent patterning of variability associated with greater emotion dysregulation. Results did not support the validity of the child report protocol, as children were less likely to complete ratings when emotionally distressed and demonstrated substantial response bias.

Sleep problems and functional disability in children with functional gastrointestinal disorders: an examination of the potential mediating effects of physical and emotional symptoms.

BACKGROUND: Sleep disturbances are increasingly recognized as a common problem for children and adolescents with chronic pain conditions, but little is known about the prevalence, type, and impact of sleep problems in pediatric functional gastrointestinal disorders (FGIDs). The objectives of the current study were two-fold: 1) to describe the pattern of sleep disturbances reported in a large sample of children and adolescents with FGIDs; and, 2) to explore the impact of sleep by examining the inter-relationships between sleep disturbance, physical symptoms, emotional problems, and functional disability in this population. METHODS: Over a 3-year period, 283 children aged 8-17 years who were diagnosed with an FGID and a primary caretaker independently completed questionnaires regarding sleep, emotional functioning, physical symptoms, and functional disability during an initial evaluation for chronic abdominal pain at a pediatric tertiary care center. A verbal review of systems also was collected at that time. Descriptive statistics were used to characterize the pattern of sleep disturbances reported, while structural equation modeling (SEM) was employed to test theorized meditational relationships between sleep and functional disability through physical and emotional symptoms. RESULTS: Clinically significant elevations in sleep problems were found in 45% of the sample, with difficulties related to sleep onset and maintenance being most common. No difference was seen by specific FGID or by sex, although adolescents were more likely to have sleep onset issues than younger children. Sleep problems were positively associated with functional disability and physical symptoms fully mediated this relationship. Emotional symptoms, while associated with sleep problems, evidenced no direct link to functional disability. CONCLUSIONS: Sleep problems are common in pediatric FGIDs and are associated with functional disability through their impact on physical symptoms. Treatments targeting sleep are likely to be beneficial in improving physical symptoms and, ultimately, daily function in pediatric FGIDs.

Longitudinal transition outcomes of youth with emotional disturbances.

OBJECTIVE: Two perspectives are offered on the transition outcomes of youth with emotional disturbances (ED) using data from the National Longitudinal Transition Study (NLTS) and the National Longitudinal Transition Study-2 (NLTS2). The first perspective compares two cohorts of youth ages 18-21 who were out of high school up to 4 years in 1990 and 2005 on their rates of high school completion, postsecondary education enrollment, employment, independent living, and criminal justice system involvement. The second perspective provides similar information from the final wave of NLTS2 data collection (2009), when young adults were ages 21-25. METHODS: Using nationally representative interview and survey data, descriptive statistics are provided for outcomes at each time point. RESULTS: Significant increases over time are apparent in rates of high school completion, postsecondary education, and arrest, and there was a significant decline in employment. Analyses of young adults with ED in 2009 show that 82.5 percent had completed high school, and 53 percent had had some postsecondary education. Although 91.2 percent had been employed at some time since high school, 49.6 percent were employed when interviewed; 63.1 percent had lived independently, 60.5 percent had been arrested, and 44.2 percent had been on probation or parole. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Youth with emotional disturbances trail the general population in positive transition outcomes, and high rates of criminal justice system involvement suggest more effort is needed, including early intervening with response to intervention (RtI) strategies and self-determination training, to help these young adults succeed after high school.

Sifneos alexithymia questionnaire in assessment of general alexithymia in patients with breast disease and breast cancer: a prospective case-control study in Finland.

BACKGROUND: In 1973, Sifneos introduced the word 'alexithymia' to describe the inability to find appropriate words to describe one's feelings. To the Authors' knowledge, the associations between alexithymia and the risk of breast cancer (BC) are rarely considered together in a prospective study. PATIENTS AND METHODS: In an extension of the Kuopio Breast Cancer Study 115 women with breast symptoms were semi-structurally interviewed in-depth, as well as being asked to complete standardised questionnaires (Beck, Forsen, MADRS, Spielberger), and all study variables were obtained before any diagnostic procedures were carried out. The investigator estimated the alexithymia of the study participants using a 5-point scale. RESULTS: The clinical examination and biopsy showed BC in 34 patients, benign breast disease (BBD) in 53 patients, and 28 individuals were shown to be healthy (HSS). There was a significance for the women with BC to have more alienation from own body (Function C, p=0.03) (mean Alexithymia score, 2.82) than those of the BBD (mean Alexithymia score, 3.40) and HSS groups (mean Alexithymia score, 3.29). The BC group had significantly more alienation from own experience (Function D, p=0.01) (mean Alexithymia score, 2.82) than the patients in the BBD group (mean Alexithymia score, 3.51) and in the HSS group (mean Alexithymia score, 3.36). The BC group also had more alienation from own feelings (Function E, p=0.05) and more deficit in self-experience (Function F, p=0.05) than the patients in the BBD group and the patients in the HSS group. CONCLUSION: The results of this study show that the patients with BC tended to have an increased risk for alexithymia.

Long-term prostate cancer survivors with low socioeconomic status reported worse mental health-related quality of life in a population-based study.

OBJECTIVE: To explore whether socioeconomic status (SES) was associated with health-related quality of life (HRQL) and health care use among long-term prostate cancer survivors. PATIENTS AND METHODS: Through urologists in the Comprehensive Cancer Center South, all 5- to 10-year prostate cancer survivors known in the Eindhoven Cancer Registry without disease progression were invited to complete the 36-item Short Form Health Survey (SF-36), the Expanded Prostate Cancer Index, and the Dutch sexual activities module. Multivariate linear regression assessed the effect of SES (based on home value and household income) on HRQL and health care use. RESULTS: Five-hundred eighty-four patients (response rate 81%) were included. Survivors with a low SES exhibited lower mental SF-36 scores (6-16 points on a 0-100 scale), independent of sociodemographic and clinical characteristics (P < .05), and hardly any differences in physical SF-36 subscales, sexual function, and urinary and bowel function and bother. Presence of serious comorbidity had a stronger predictive value for HRQL than SES. Health care use did not seem to be associated with SES. CONCLUSIONS: Prostate cancer survivors with a low SES exhibited a worse mental but not physical HRQL than those with a higher SES. Long-term health outcomes of patients with low SES may be maximized by paying extra attention to comorbid conditions.

The utility of considering interpersonal problems in the assessment of bulimic features.

Previous research suggests that heterogeneity in bulimic features can be explained in part by pathoplastic, or varying, interpersonal problems. The present study compared groups of women with bulimic features (N=110) defined by varying interpersonal problems (warm-dominant, warm-submissive, cold-submissive, or cold-dominant) with regard to comorbid psychopathology, personality characteristics, and the influences of dietary restraint and negative affectivity on bulimic psychopathology. As predicted, group differences were not explained by severity of eating-related pathology, socially desirable responding, or the interpretability of interpersonal profiles, although groups unexpectedly differed in depressive symptoms. The warm-submissive group had highest scores on adaptive personality characteristics, including, agreeableness, extraversion, and conscientiousness. As hypothesized, the influence of negative affect and dietary restraint on bulimic symptoms differed as a function of interpersonal style, perhaps suggesting that interpersonal problem heterogeneity may mark different etiological pathways for bulimic psychopathology. Finally, interpersonal problems incremented bulimic features in predicting depressive symptoms. Overall, these results highlight the added value of considering pathoplastic interpersonal problems in addition to clinical diagnoses in the assessment of eating disorders.

[The assessment of suicidal risk in the concept of the presuicidal syndrome, and the possibilities it provides for suicide prevention and therapy--review]. / Ocena zagrozenia samobójstwem w koncepcji syndromu presuicydalnego jako perspektywy dla terapii i profilaktyki samobójstw.

OBJECTIVE: To present Erwin Ringel's theory of the presuicidal syndrome as an instrument for the assessment of suicidal risk. METHOD: The literature regarding the presuicidal syndrome was reviewed. RESULTS: As it is evident from the research and works by Ringel, and also from the works by other classics of suicidological literature, such as Farberow, Poldinger, Schneidmann, Beck, and B6hme, the discovery of the presuicidal syndrome has opened up new vistas for the therapy of suicidal tendencies. The knowledge of the nature of the presuicidal syndrome indicates that a specific "anti-suicide" therapy has to be applied. The principal aims of such a therapy include the removal of the patient's feeling of alienation by the creation of a good doctor-patient relationship, the creation of the conditions enabling the patient to vent his/her aggression verbally, the removal of the presuicidal narrowing of the patient's consciousness by the reinforcement of the effective, positive behaviour, and the stimulation of the patient's imagination towards the formulation of new aims in life. CONCLUSION: The concept of the presuicidal syndrome, although somewhat forgotten, still can enhance the understanding of the psychopathology of suicide, contribute to the effective identification of individuals endangered by the occurrence of suicidal tendencies, and contribute to the increase in the effectiveness of the therapy required. Finally, the present authors suggest that the presuicidal syndrome, as a special multifactor psychopathological phenomenon, should be recognized as a diagnostic unit, thus filling in the present gap in the classifications of mental illnesses.

The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice: the emerging field of behavioral cardiology.

Observational studies indicate that psychologic factors strongly influence the course of coronary artery disease (CAD). In this review, we examine new epidemiologic evidence for the association between psychosocial risk factors and CAD, identify pathologic mechanisms that may be responsible for this association, and describe a paradigm for studying positive psychologic factors that may act as a buffer. Because psychosocial risk factors are highly prevalent and are associated with unhealthy lifestyles, we describe the potential role of cardiologists in managing such factors. Management approaches include routinely screening for psychosocial risk factors, referring patients with severe psychologic distress to behavioral specialists, and directly treating patients with milder forms of psychologic distress with brief targeted interventions. A number of behavioral interventions have been evaluated for their ability to reduce adverse cardiac events among patients presenting with psychosocial risk factors. Although the efficacy of stand-alone psychosocial interventions remains unclear, both exercise and multifactorial cardiac rehabilitation with psychosocial interventions have demonstrated a reduction in cardiac events. Furthermore, recent data suggest that psychopharmacologic interventions may also be effective. Despite these promising findings, clinical practice guidelines for managing psychosocial risk factors in cardiac practice are lacking. Thus, we review new approaches to improve the delivery of behavioral services and patient adherence to behavioral recommendations. These efforts are part of an emerging field of behavioral cardiology, which is based on the understanding that psychosocial and behavioral risk factors for CAD are not only highly interrelated, but also require a sophisticated health care delivery system to optimize their effectiveness.

Occupational assault among community care workers.

The author presents the findings of a study that attempted to analyze the frequency, trend, and pattern of workplace assaults among community care workers who provide care for severely emotionally and behaviorally disturbed children in a state government agency in Australia between 1997 and 2000. He identifies the high risk groups and discusses activities for prevention opportunities.

Improving general practitioners' assessment and management of suicide risk.

Standards for assessing and managing suicide risk were developed and incorporated into a guidance manual for general practitioners. The effects of the manual on opinions and practice were evaluated using a quasi-experimental controlled before/after design, comparing participating general practitioners with others who did not use the manual. Thirty four general practitioners participated over a six-month period. The intervention group showed changes in perceptions, with increased satisfaction with their own methods and in their recognition and assessment of suicide risk. Their practice changed, with increased recording of relevant factors in notes. The comparison group did not change in these ways. It is concluded that general practitioners' practice and opinions in assessing and managing suicide risk were significantly improved using a minimal intervention. Given the importance of the topic and the small size of this study, further research is needed, examining changes in professional practice, knowledge and attitudes.

Relevancia del estudio tiroideo en pacientes con trastornos psiquiátricos / Thyroid function assessment in psychiatric patients

Background: Thyroid dysfunction is frequent in psychiatric outpatients and the correction of their endocrine abnormalities seems to improve the response to psychopharmacologic treatment. Aim: To retrospectively explore the frequency of thyroid abnormalities in psychiatric autpatients. Material and methods: Clinical charts and thyroid assesment of 102 psychiatric patients aged 40.8ñ15 years old (28 male) seen between April 1995 and 1996 were reviewed. Endocrine diagnosis was made according to international criteria and psychiatric diagnosis was made by a single psychiatryist following DSM IV criteria. Results: Forty patients (39.2 percent) had thyroid abnormalities. Thirteen (12.7 percent) had a diagnosis of thyroid problems and were in treatment before they came to the psychiatric clinic. Sixteen patients had hypothyroidism (40 percent), seven had subclinical hypothyroidism (17.5 percent), 12 were euthyroid but had goiter or positive thyroid antibodies (30 percent) and 5 individuals had hyperthyroidism (12.5 percent). The most frequent thyroid abnormality was the presence of positive thyroid antibodies in 16 cases (15.7 percent). No specific associaton was found between psychiatric and endocrine diagnoses. Conclusions: The desing of this study prevents to draw conclusions about prevalence of thyroid alterations in psychiatric patients. Nevertheless results support the need for routine thyroid assessment in this specific population

Social factors in alexithymia.

Social characteristics of alexithymic individuals were examined in a population-based study of 2,682 middle-aged men from Eastern Finland. Alexithymia, referring to difficulties in identifying and verbally describing inner feelings, was assessed using the Toronto Alexithymia Scale (TAS). Men whose high TAS score suggested reduced ability in verbal emotional expression were more often unmarried and had low levels of social contacts and acquaintances. Education, income, and occupational status were inversely related to the TAS score. These associations remained statistically significant after adjustment for confounding factors. The results suggest that alexithymia could be viewed not only as a psychological phenomenon, but also partly as a socially determined one.

A comparison of personality characteristics, family relationships, and drug-taking behavior in low and high socioeconomic status adolescents who are drug abusers.

Low socioeconomic status (SES) and high SES adolescents who met the DSM-III criteria for drug abuse were compared with respect to personality characteristics, family relationships, and drug-taking behavior. SES was determined by parents' income, education, and occupation. The two groups did not differ significantly with respect to self-esteem, quality of family relationships, impulse control, moral development, and drug-taking behavior. However, high SES adolescents were more depressed (p less than .009) and more anxious (p less than .02) than low SES adolescents, and these findings lent support to the argument that low and high SES drug abusers differ in personality and therefore require different kinds of treatment interventions.

Compensation and non-compensation chronic pain patients compared for DSM-III operational diagnoses.

Two hundred and eighty-three mixed chronic pain patients, consecutive admissions, were diagnostically evaluated as per DSM-III, Axis I, Axis II or personality type psychiatric operational criteria. Controlling for primary organic treatment diagnosis, age and race, statistical comparisons were made between male compensation patients (n = 93) and male non-compensation patients (n = 23) and between female compensation patients (n = 38) and female non-compensation patients (n = 28) for all DSM-III diagnoses. Male compensation patients were significantly overrepresented for these diagnostic groups: conversion disorder (somatosensory type); combined personality disorders; and passive-aggressive personality disorder. Male non-compensation patients were significantly overrepresented for these diagnostic groups: no diagnosis on Axis I; combined personality types; and compulsive personality type. Female compensation patients were significantly overrepresented for conversion disorder (somatosensory) only. Female non-compensation patients were significantly overrepresented for generalized anxiety disorder and combined anxiety syndromes. Compensation chronic pain patients may be at risk for some psychiatric disorders not previously identified: conversion disorder (somatosensory), and personality disorders.

Assessment of alexithymia in posttraumatic stress disorder and somatic illness: introduction of a reliable measure.

The authors examined ratings on four scales of alexithymia in 45 patients in four groups: Vietnam veterans in inpatient (Inpt-PTSD) or outpatient (Outpt-PTSD) treatment for posttraumatic stress disorder (PTSD), patients on a medical service with somatic illnesses that have been the subject of psychosomatic research (Somatic), and a comparison group of psychiatric inpatients with a diagnosis of affective disorder (Affective). The data suggest a greater degree of alexithymia in the Inpt-PTSD and Somatic samples than in the Affective patients. In addition, the Inpt-PTSD and Somatic groups exhibited a similar degree of alexithymia. This study also introduces a novel measure of alexithymia, the Alexithymia Provoked Response Questionnaire (APRQ), which showed a high degree of interrater reliability and a greater degree of correlation with the Beth Israel Psychosomatic Questionnaire (BIPQ) than a MMPI subscale or the Schalling-Sifneos scale.

Childhood impairments and subsequent social adjustment.

The relationship of a variety of childhood impairments to subsequent social adjustment measures of occupations, agency utilization, social participation, and arrest records was examined. Generally, results indicated that impaired persons adjust quite well in some respects but not so well in others. There were differential social adjustments by type of impairment and by age, sex, ethnicity, and socioeconomic status. The data analysis suggests complex relationships between impairment and social adjustment.