Quality of life and burden in caregivers of youth with obsessive-compulsive disorder presenting for intensive treatment.

BACKGROUND: Pediatric obsessive-compulsive disorder (OCD) is associated with deleterious familial effects; caregivers are often enmeshed in the disorder and can experience considerable burden and decreased quality of life (QoL). Consequently, this study examined burden and QoL in caregivers of youth with OCD enrolled in an intensive outpatient or partial hospitalization program. METHOD: The relationships between caregiver QoL and burden and the following variables were investigated: OCD symptom severity, functioning (youth functional impairment, general family functioning), family (family accommodation, parental relationship satisfaction, positive aspects of caregiving), and comorbid psychopathology (caregiver anxiety and depressive symptoms, youth internalizing and externalizing behaviors). Seventy-two child and caregiver dyads completed clinician- and self-rated questionnaires. RESULTS: Components of caregiver QoL correlated with caregiver-rated functional impairment, family accommodation, youth externalizing behaviors, and caregiver psychopathology. Aspects of caregiver burden correlated with child OCD symptom severity, functional impairment related to OCD, as well as caregiver and child comorbid psychopathology. Caregiver depressive symptoms predicted caregiver QoL, and caregiver depressive symptoms and child externalizing symptoms both predicted caregiver burden. Caregiver burden did not mediate the relationship between obsessive-compulsive symptom severity and caregiver QoL. CONCLUSION: Ultimately, elucidating factors associated with increased caregiver burden and poorer QoL is pertinent for identifying at-risk families and developing targeted interventions.

Role of religious attendance and identity conflict in psychological well-being.

A sample of individuals who identified as gay or lesbian were administered measures of church attendance, their religious organization's view of homosexuality, perceived conflict between religious faith identity and sexual orientation identity, social support, depression, and generalized anxiety. Among participants who rated their church as rejecting of homosexuality, greater frequency of attendance was related to a higher incidence of GAD symptoms, but not depression. No correlation was found for those attending accepting faith communities. Those who attend rejecting faith communities attended services less often, experienced greater identity conflict, and reported significantly less social support than those of the Accepted group. Regression analyses indicated that identity conflict and social support did not fully account for the relationship between attendance and GAD symptoms. Overall, findings from the current study support previous suggestions that participation in conservative or rejecting religious communities may adversely affect the emotional well-being of GL individuals.

Yersinia enterocolitica associated myopericarditis: case report and review of the literature.

We report a case of myopericarditis associated with Yersinia enterocolitica infection in an otherwise well 50-year-old man. We discuss the clinical features, microbiology and treatment of this rare cause of myopericarditis.

Quality of life in children and adolescents with obsessive-compulsive disorder: The Pediatric Quality of Life Enjoyment and Satisfaction Questionnaire (PQ-LES-Q).

The current study examined quality of life (QOL) and its clinical correlates among 225 intensive treatment-seeking children and adolescents with obsessive-compulsive disorder (OCD) using the Pediatric Quality of Life Enjoyment and Satisfaction Questionnaire (PQ-LES-Q). Youth completed the PQ-LES-Q along with self-report measures assessing functional impairment, anxiety sensitivity, OCD symptoms, nonspecific anxiety, depression, and social anxiety. Parents completed measures on their child's anxiety, the presence of inattention/hyperactivity, depression, functional impairment, and frequency of family accommodation of symptoms. Contrary to expectation, child-reported OCD symptoms did not significantly predict QOL; however, lower overall QOL was strongly associated with the presence of comorbid major depressive disorder (g=3D -0.76) and slightly related to comorbid social phobia (g=3D -0.36). These results suggest that assessing and addressing comorbid conditions in the treatment of youth with OCD is an important component of intensive treatment.

Development and Psychometric Evaluation of the Children's Yale-Brown Obsessive-Compulsive Scale Second Edition.

OBJECTIVE: To develop and examine the psychometric properties of the Children's Yale-Brown Obsessive-Compulsive Scale Second Edition (CY-BOCS-II) in children and adolescents with obsessive-compulsive disorder (OCD). METHOD: Youth with OCD (N = 102; age range 7-17 years), who were seeking treatment from 1 of 2 specialty OCD treatment centers, participated in the study. The CY-BOCS-II was administered at an initial assessment, and measures of OCD symptom severity, anxiety and depressive symptoms, behavioral and emotional problems, and global functioning were administered. Inter-rater and test-retest reliabilities were assessed on a subsample of participants (n = 50 and n = 31, respectively) approximately 1 week after intial assessment. RESULTS: The CY-BOCS-II demonstrated moderate-to-strong internal consistency (α = 0.75-0.88) and excellent inter-rater (intraclass correlation coefficient = 0.86-0.92) and test-retest (intraclass correlation coefficient = 0.95-0.98) reliabilities across all scales. Construct validity was supported by strong correlations with clinician-rated measures of OCD symptom severity and moderate correlations with measures of anxiety symptoms. Exploratory factor analysis showed a 2-factor structure, which was generally inconsistent with its adult counterpart, the Yale-Brown Obsessive-Compulsive Scale Second Edition. CONCLUSION: Initial findings support the CY-BOCS-II as a reliable and valid measure of obsessive-compulsive symptoms in youth.

Predictors of parent-child agreement on child anxiety diagnoses on the ADIS-IV-C/P.

Diagnostic agreement between parents' and children's reports on children's anxiety problems is notoriously poor; however, very few investigations have examined specific predictors of inter-rater agreement on child anxiety diagnoses. This study examined predictors of categories of parent and child diagnostic endorsement on the Anxiety Disorders Interview Schedule for Children-IV. One hundred eight children (ages 7-13) and their parents completed structured diagnostic interviews for non-OCD/PTSD anxiety diagnoses and paper and pencil measures of functioning and impairment in a variety of domains. Parent-child agreement was statistically significant for social phobia and separation anxiety disorder, but was overall poor for all anxiety diagnoses. Externalizing disorder status, family accommodation frequency, and child rated impairment in various domains differentially predicted informant discrepancies for different anxiety disorders. These data are among the first to suggest variables that may explain parent-child concordance.

Evidence-Based Psychological Treatments of Pediatric Mental Disorders.

With many youth presenting to primary care settings for mental health difficulties, knowledge of the respective evidence-based psychotherapies is imperative in ensuring that these youth receive the appropriate interventions in a timely manner. Most frequently, children present with internalizing and/or externalizing disorders, which cover a broad range of common pediatric mental disorders. Treatments of these disorders generally incorporate cognitive and/or behavioral components, which are derived from theoretical underpinnings and empirical support. Although the interventions share common components, they are distinctive in nature and are further tailored toward the idiosyncratic needs of children and their families. Careful consideration of the apposite intervention and individual needs of youth are pertinent to the effective amelioration of symptomology.

Clinical characteristics and predictors of hoarding in children with anxiety disorders.

OBJECTIVE: This investigation was conducted to describe the clinical of characteristics of anxious children with significant hoarding behavior and to examine the contributions of anxiety, obsessive compulsive, and inattentive and hyperactive/impulsive symptoms in the prediction of hoarding. METHOD: One hundred nine children seeking treatment for an anxiety disorder and their parents completed clinician-administered and parent-report measures of emotional and behavioral symptoms, functional impairment, and hoarding symptoms. RESULTS: Elevated levels of hoarding were reported for 22% of the sample. Children with elevated hoarding scored significantly higher on measures of anxiety, obsessive-compulsive, attention, social, and thought problems, rule-breaking, aggression, and overall functional impairment and had higher rates of major depressive disorder than children without hoarding. Attention problems predicted hoarding symptomology over-and-above the contributions of either anxiety or obsessive-compulsive symptoms. CONCLUSIONS: Findings suggest a pattern of behavioral and emotional dysregulation for children who hoard and provide further insight into the relationships between anxiety, attention problems, and hoarding.