Improvement in social deficits in autism spectrum disorders using a theatre-based, peer-mediated intervention.

Social Emotional NeuroScience Endocrinology Theatre is a novel intervention program aimed at improving reciprocal social interaction in youth with autism spectrum disorder (ASD) using behavioral strategies and theatrical techniques in a peer-mediated model. Previous research using a 3-month model showed improvement in face perception, social interaction, and reductions in stress. The current study assessed a 2-week summer camp model. Typically developing peers were trained and paired with ASD youth (8-17 years). Social perception and interaction skills were measured before and after treatment using neuropsychological and parental measures. Behavioral coding by reliable, independent raters was conducted within the treatment context (theatre) and outside the setting (playground). Salivary cortisol levels to assess physiological arousal were measured across contexts (home, theatre, and playground). A pretest-posttest design for within-group comparisons was used, and prespecified pairwise comparisons were achieved using a nonparametric Wilcoxon signed-rank test. Significant differences were observed in face processing, social awareness, and social cognition (P < 0.05). Duration of interaction with familiar peers increased significantly over the course of treatment (P < 0.05), while engagement with novel peers outside the treatment setting remained stable. Cortisol levels rose on the first day of camp compared with home values yet declined by the end of treatment and further reduced during posttreatment play with peers. Results corroborate previous findings that the peer-mediated theatre program contributes to improvement in core social deficits in ASD using a short-term, summer camp treatment model. Future studies will explore treatment length and peer familiarity to optimize and generalize gains.

Current approaches to the assessment and management of anger and aggression in youth: a review.

BACKGROUND: Anger and its expression represent a major public health problem for children and adolescents today. Prevalence reports show that anger-related problems such as oppositional behavior, verbal and physical aggression, and violence are some of the more common reasons children are referred for mental health services. METHODS: An extensive review of the literature was conducted using the following online search engines: Cochrane, MEDLINE, PsychINFO, and PubMed. Published and unpublished articles that met the following criteria were included in the review: (a) experimental or quasi-experimental research designs; (b) nonpharmacologic, therapy-based interventions; and (c) study participants between 5 and 17 years of age. RESULTS: Cognitive-behavioral and skills-based approaches are the most widely studied and empirically validated treatments for anger and aggression in youth. Commonly used therapeutic techniques include affective education, relaxation training, cognitive restructuring, problem-solving skills, social skills training, and conflict resolution. These techniques, tailored to the individual child's and/or family's needs, can foster the development of more adaptive and prosocial behavior.

Hiponatremia sintomática secundaria a tratamiento conjunto anticomicial y antidepresivo: ¿riesgo de muerte súbita en epilepsia? / Symptomatic secondary hyponatremia due to combined treatment anticonvulsant and antidepressant: risk of sudden death in epilepsy?

La notable incidencia de epilepsia en nuestro medio, con la presencia, cada vez más frecuente, de refractariedad terapéutica, obliga a la politerapia anticomicial. Si partimos del hecho, de que muchas de las epilepsias tienen una base secundaria, con trastornos comportamentales asociados, podemos comprender la cada vez más habitual asociación entre fármacos anticomiciales y antidepresivos. Presentamos el caso clínico de una mujer de 37 años, afecta de epilepsia farmacorresistente asociada a síndrome depresivo exógeno, en tratamiento conjunto con Carbamacepina, Lamotrigina y Venlafaxina que sufre cuadro sincopal secundario a hiponatremia sintomática, cuya patogénesis radica en un mecanismo de secreción inadecuada de hormona antidiurética (SIADH). La relevancia de este caso radica en el hecho de que la hiponatremia generada por esta combinación farmacológica, hasta ahora, no ha sido descrita en la literatura. Esta anomalía electrolítica puede derivar en efectos secundarios neurológicos y cardiovasculares, en ocasiones tan relevantes, como para producir el fenómeno conocido como muerte súbita en el paciente epiléptico (SUDEP). Recomendamos, por ello, un estricto control iónico en aquellos pacientes en tratamiento conjunto anticomicial y antidepresivo, a fin de evitar episodios paroxísticos vasculares y minimizar el riesgo de SUDEP

The notable incidence of epilepsy in the general population, with the presence, more and more frequent of refractory therapeutic, it forces the anticonvulsant polytherapy. If we depart from the fact, that many of the epilepsies have a secondary cause, with affective disorders associate, we can understand the most habitual association of anticonvulsant and antidepressant. We present the clinical case of a 37-year-old-woman with refractory therapeutic epilepsy associated to exogenous depressive syndrome, in combined treatment with Carbamazepine, Lamotrigine and Venlafaxine, that suffers a episode of syncope secondary to symptomatic hyponatraemia, generated by syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The relevance of this case resides in the fact that the hyponatraemia generated by this pharmacological combination, up to now, it has not been described in the literature. This electrolytic anomaly can derive in secondary neurological and cardiovascular effects, in so outstanding occasions, as to produce the phenomenon denominated sudden death in the epileptic patient (SUDEP). We recommended a strict ionic control in those patients that require anti-epileptic and anti-depressant treatment combined, in order to avoiding paroxistic vascular episodes and to minimize the risk of SUDEP

[Asperger syndrome - a too late diagnosed disorder?]. / Asperger-Syndrom - eine zu spät diagnostizierte Störung?

Asperger syndrome is a disorder within the autistic spectrum, which was first described by Hans Asperger in 1944. It belongs to the group of pervasive developmental disorders and is particularly characterized by qualitative impairments of social interaction and communication as well as distinct special interests and stereotyped patterns of behaviour. We present a patient, showing the typical behavioural symptoms of the Asperger syndrome, which were first diagnosed at the age of sixteen.

[KES--training for parents of children with conduct behaviour problems]. / Kompetenztraining für Eltern sozial auffälliger und aufmerksamkeitsgestörter Kinder (KES).

Conduct behaviour problems are the most frequent problems in childhood and adolescence. They make special demands on parenting. Possible causes for the emergence and maintenance of this distinctive features can be summarized in a bio-psychosocial disturbance model. The parental educating behaviour is thereby usually not the cause of the childlike behaviour problems, but can stabilize initial behaviour problems. Parenting trainings are therefore considered as an effective possibility of intervention and prevention of childlike behaviour disturbances. In this article contents and effectiveness of the "Kompetenztraining für Eltern sozial auffälliger und aufmerksamkeitsgestörter Kinder (KES)" (Lauth a. Heubeck 2005) are to be represented. The KES is a secondary preventive parenting training, which is offered as an intensive short time intervention and accomplished in groups. The contents of the training fit with the individual problems of parents' everyday educating situations. In the available study this training is operate in three variants in order to examine differential training effects apart from the general effectiveness. The results show a general effectiveness of the KES. Burdens in family educating situations can be reduced likewise the experienced stress in the family. The results also indicate, that the parents of the group with behaviour exercises seems to benefit most from the training. They do not only speak about their problems (alternative treatment) or get suggestions for changes in the educating behaviour (group without behaviour exercises). They are also requested to practice the connected skills in the form of role plays and homework to be able to transfer into everyday life.

Specific cognitive deficits and differential domains of social functioning impairment in schizophrenia.

There is considerable inconsistency in findings regarding the relationship between specific cognitive deficits and social impairment in patients with schizophrenia. This inconsistency may relate to variability across studies in how social functioning is measured and preliminary evidence suggests that different indices of social functioning (e.g., laboratory test, community assessment) may have different cognitive correlates. The present study examined this issue by evaluating the relationships between cognitive deficits (including social cognitive deficits), role-play test performance, and community social functioning in 28 inpatients with schizophrenia. We expected the two measures of social functioning to have only modest convergence with each other. Moreover, informed by the literature on cognitive functioning in schizophrenia, we identified specific cognitive processes that were hypothesized to be associated with role-play performance (delayed verbal memory and attentional vigilance) and social functioning in the community (delayed verbal memory and executive functioning). As expected, the two measures of social functioning were modestly correlated with each other. Community social functioning was associated with a relatively constrained pattern of cognitive deficits and received a significant contribution (Deltar2=0.24) from specific cognitive processes beyond that of general cognitive functioning and symptom severity. In contrast to our hypotheses, role-play test performance was associated with a wide range of cognitive impairments and received little contribution from the specific cognitive processes beyond the effects of general cognitive functioning. Community social functioning, but not role-play test performance, was significantly associated with social cognition. These findings highlight the importance of conceptualizing social functioning as a multidimensional construct for schizophrenia research.

Practice parameter for the assessment and treatment of children and adolescents with reactive attachment disorder of infancy and early childhood.

This parameter reviews the current status of reactive attachment disorder with regard to assessment and treatment. Attachment is a central component of social and emotional development in early childhood, and disordered attachment is defined by specific patterns of abnormal social behavior in the context of "pathogenic care." Clinically relevant subtypes include an emotionally withdrawn/inhibited pattern and a socially indiscriminate/disinhibited pattern. Assessment requires direct observation of the child in the context of his/her relationships with primary caregivers. Treatment requires establishing an attachment relationship for the child when none exists and ameliorating disturbed attachment relationships with caregivers when they are evident. Coercive treatments with children with attachment disorders are potentially dangerous and not recommended.

Interviewing principles for the psychiatrically aware sports medicine physician.

This article describes how sports medicine physicians can best approach the diagnoses of mental illness in athletes. Examples of psychiatric problems common to athletes, their incidences in the population, and diagnostic tips to ferret them out are given. Vignettes of well-known athletes who have had these problems are included. Each highlights how the lack of diagnostic awareness of mental health issues in the athletic community and the stigma of "mental illness" prevented the athlete from getting treatment sooner.

Anger expression and essential hypertension: behavioral response to confrontation.

OBJECTIVE: The purpose of this study was to examine the range of anger-expressive behaviors and social competencies among essential hypertensive patients. METHODS: Behavioral reactions to both neutral and anger-evoking role-play interactions were measured in 26 hypertensive and 15 normotensive patients. Social behaviors were assessed using self-report measures of anger expression, assertiveness, self- and other-ratings of social competence and behavioral measures of anger expression observed during role-play interactions. RESULTS: Hypertensive patients showed less eye contact, used fewer positive assertive statements and were rated as being less assertive during confrontational role-play scenarios than normotensive controls. Hypertensive patients also exhibited higher pulse pressure reactions to confrontation than normotensives, particularly hypertensive patients who expressed anger overtly. CONCLUSION: Essential hypertension is associated with specific social skill deficits that are only apparent during the assertive expression of anger.

Cognitive and behavioural effects of chronic stimulation of the subthalamic nucleus in patients with Parkinson's disease.

OBJECTIVE: To investigate cognitive and behavioural effects of bilateral lead implants for high frequency stimulation (HFS) of the subthalamic nucleus in patients with Parkinson's disease; and to discriminate between HFS and the effects of surgical intervention on cognitive function by carrying out postoperative cognitive assessments with the stimulators turned on or off. METHODS: Motor, cognitive, behavioural, and functional assessments were undertaken in 20 patients with Parkinson's disease before implantation and then at three, six, and 12 months afterwards. Nine patients were also examined 18 months after surgery. Postoperative cognitive assessments were carried out with stimulators turned off at three and 18 months, and turned on at six and 12 months. RESULTS: Cognitive assessment showed a significant postoperative decline in performance on tasks of letter verbal fluency (across all postoperative assessments, but more pronounced at three months) and episodic verbal memory (only at three months, with stimulators off). At three, six, and 12 months after surgery, there was a significant improvement in the mini-mental state examination and in a task of executive function (modified Wisconsin card sorting test). On all postoperative assessments, there was an improvement in parkinsonian motor symptoms, quality of life, and activities of daily living while off antiparkinsonian drugs. A significant postoperative decrease in depressive and anxiety symptoms was observed across all assessments. Similar results were seen in the subgroup of nine patients with an 18 month follow up. Following implantation, three patients developed transient manic symptoms and one showed persistent psychic akinesia. CONCLUSIONS: Bilateral HFS of the subthalamic nucleus is a relatively safe procedure with respect to long term cognitive and behavioural morbidity, although individual variability in postoperative cognitive and behavioural outcome invites caution. Stimulation of the subthalamic nucleus does not per se appear to impair cognitive performance in patients with Parkinson's disease and may alleviate the postoperative decline in verbal fluency.

Dolor abdominal recurrente: un trastorno somatomorfo / Recurrent abdominal pain: a somatomorf disorder

El dolor abdominal recurrente es un problema común en pediatría. La etiología es desconocida, aunque se relaciona con un origen psicosomático. En este trabajo analizamos el dolor abdominal recurrente como trastorno somatomorfo indiferenciado, según los criterios del DSM-IV, y estudiamos los factores psicológicos asociados a la etiología, fisiopatología, diagnóstico y tratamiento (AU)

Psychophysiological correlates of social skills deficits in persons with schizophrenia.

Social skill deficits in schizophrenia profoundly affect patients' life-long outcome, although the profile of the underlying cognitive dysfunction still remains a matter of debate. In the present study, we investigated the relationship between social skills and event-related potentials (ERPs) in an auditory selective attention task, in addition to the neurocognitive indices obtained from the degraded-stimulus continuous performance test (CPT) and clinical indices, such as Brief Psychiatric Rating Scale (BRPS) and global assessment of function (GAF) scores. Social skills were assessed using a Japanese version of the structured role play test. Fourteen persons with schizophrenia participated in the study. Non-verbal skills showed a positive correlation with GAF, the performance level, N1 and N2b amplitude in the ERP task, and hit rate in the CPT, and a negative correlation with reaction time in the CPT. Verbal communication skills showed a positive correlation with GAF, the performance level and N2b amplitude in the ERP task, and hit rate in the CPT, and a negative correlation with reaction time in the CPT. Processing skills showed a positive correlation with the performance level and N1 amplitude in the ERP task and a negative correlation with reaction time in the CPT. These findings suggested that the social skill deficits of persons with schizophrenia were related to the vigilance level and controlled stimulus detection processing.

Reduction of severe aggressive behaviour in acquired brain injury: case studies illustrating clinical use of the OAS-MNR in the management of challenging behaviours.

Challenging behaviour, especially when this takes the form of aggression, may impede or prevent progress in neurorehabilitation. Despite its prevalence, the literature on management of aggression after brain injury is not extensive. It has been suggested that the 'Overt Aggression Scale-Modified for Neurorehabilitation' (OAS-MNR) could be used to help standardize future studies of aggressive behaviour. It was also suggested that this scale has sufficient properties to be useful in clinical work. In this paper, three case studies are described which attempt to illustrate the potential value of the OAS-MNR in neurorehabilitation. The use of the scale also provides evidence relating to the continued efficacy of the neurobehavioural model. In the first study, two cases are described in which reduction in aggression occurred through participation in individualized, needs-led holistic treatment programmes, which incorporated multiple interventions. These were based on neurobehavioural principles. In the second study, a further single case was presented which illustrated how the scale may be used to generate hypotheses regarding aggressive behaviour and to drive treatment. Causation and maintenance of aggression are discussed, especially with regard to cognitive impairment. Finally, practical points relating to the use of the OAS-MNR in clinical practice are reviewed.

The observer perspective: biased imagery in social phobia, agoraphobia, and blood/injury phobia.

Clark and Wells' (1995): 'A cognitive model of social phobia'. In Social phobia: Diagnosis, assessment, and treatment (pp. 69-93), R. G. Heimberg, M. R. Liebowitz, D. A. & F. R. Hope (eds.); cognitive model of social phobia proposes that social phobics generate a negative impression of how they appear to others. This impression often occurs in the form of an image from an "observer" perspective in which social phobics can see themselves as if from another person's vantage point. This study investigated the specificity of the observer perspective among patients with social phobia, agoraphobia, and blood/injury phobia. All participants were asked to recall and imagine a recent anxiety-provoking social situation and a non-social/non-anxiety-provoking situation, and rate their perspective for each. Consistent with predictions only patients with social-evaluative concerns (social phobics and agoraphobics) reported observer perspectives for anxiety-provoking social situations. Only social phobics showed a significant shift from an observer to a field perspective across the two conditions. The clinical implications of these findings are briefly discussed.

Persisting childish behavior after bilateral thalamic infarcts.

We report a case with bilateral paramedian thalamic infarcts. The patient showed a dramatic personality change characterized by childish behavior and euphoria; which remained unchanged for 2 years after the onset. 'Vorbeireden' characterized by approximate answers was also observed. Anterograde amnesia had quite improved after 2 years, while retrograde amnesia for 1 year prior to the stroke onset and vertical gaze palsy remained unchanged. An MRI scan demonstrated bilateral medial thalamic and right midbrain infarcts without other lesions in the brain. A position emission tomography study showed that cerebral metabolic rate for glucose was markedly decreased in both thalami and in the cerebellum, and only slightly decreased in the parietal and occipital cortical regions. Cerebral metabolic rates of glucose in the frontal and temporal cortices were within normal range. The paramedian thalamic lesions per se may be responsible for the patient's personality change, 'Vorbeireden', and amnesia.

An ethnomedical perspective of Anglo-American psychiatry.

Although psychiatry is part of Western biomedicine and its roots in neurobiology are widely appreciated, Anglo-American psychiatry addresses social behavior that is deviant and potentially stigmatizing and is said to uniquely engage in social control. Moreover, its concerns overlap and compete with those of other regulatory institutions of the state. For these reasons, the manner in which psychiatry operates is subject to challenge, criticism, and controversy. The author proposes that a look at psychiatry from the vantage point of ethnomedicine--the comparative study of medical systems--can enhance an appreciation of the current controversies in psychiatry and psychiatry's role as a medical institution.

"Folk" criteria for the diagnosis of mental illness in rural Laos: on being insane in sane places.

"Folk" criteria for identifying the mentally ill, as distinguished from folk theories about the causes of mental illness, have been comparatively neglected in cultural psychiatry. The authors describe the criteria by which villagers in Laos labeled 35 subjects as baa (insane). Unprovoked assaultive or destructive behavior, social isolation, self-endangerment due to neglect of personal needs, nonviolent but socially disruptive or inappropriate behavior, and inability to do productive work were found to be important folk criteria. The authors emphasize that folk criteria for mental illness are determined primarily by the persistence of socially dysfunctional behavior rather than by disturbances in thought and affect.