Involvement of Guns in Nonfatal Conflict Between Adult Children and Their Parents.

The objectives of the present analyses are to examine the frequency, nature, and correlates of nonfatal gun use in incidents of conflict between adult children and their parents, to which police were summoned. A cross-sectional study design was used with all cases of domestic violence to which police were called between adult children and their parents, in Philadelphia, PA, in 2013 (N = 6,248). Data were drawn from forms required to be completed by police when responding to domestic violence calls for assistance. A series of multivariate logistic regression models were estimated. Of the 6,248 incidents, 5,486 involved no weapon, 522 involved a bodily weapon, 190 involved a non-gun external weapon, and 50 involved a gun. Guns were most often used to threaten victims (66%), with guns less often fired (6%) or used to pistol whip victims (4%). Compared to incidents involving a bodily weapon, when guns were involved, offenders were less likely to have pushed, grabbed, or punched the victim and victims were less likely to have visible injuries; however, offenders were more likely to have threatened victims and victims were more likely to be observed as frightened. Police officers intervened similarly to incidents involving guns vs. bodily weapons. This is the first study we are aware of to focus on nonfatal gun use between family members who are not intimate partners, with the results extending much of what is known regarding nonfatal gun use among intimate partners to nonfatal gun use among adult children and parents.

The relationship between emotion regulation and pain catastrophizing in patients with chronic pain.

OBJECTIVES: Pain catastrophizing (PC) is a cognitive/emotional response to and in anticipation of pain that can be maladaptive, further exacerbating pain and difficulty in emotion regulation (ER). There is a lack of research on the interplay between PC and ER and its impact on pain. Our aim was to investigate whether ER exacerbated the pain experience through PC. METHODS: Adults with chronic non-cancer pain of >3 months' duration (n = 150) who were taking opioid medication were recruited from a large medical center in Pennsylvania. A battery of questionnaires was conducted to gather data on demographics, substance use, mental health histories, and health and pain outcomes. Measures used included the 18-Item Difficulties in Emotion Regulation Scale, the Pain Catastrophizing Scale, the Brief Pain Inventory-Short Form, and the Hospital Anxiety and Depression Scale. A structural equation model with latent variables was conducted to examine our aim. RESULTS: Both pain interference and severity were significantly positively associated with several psychosocial variables, such as anxiety, depression, ER constructs, PC, and distress intolerance. The associations between subscales and pain interference were larger than the associations between subscales and pain severity. PC fully mediated the paths from ER to pain experiences. DISCUSSION: Our results highlight the importance of several cognitive and emotional constructs: nonacceptance of negative emotions, lack of emotional awareness, magnification of the pain experience, and a sense of helplessness. Furthermore, by showing the indirect effects of PC in affecting ER and pain, we posit that ER, mediated by PC, might serve a critical role in influencing the pain experience in patients with chronic pain.

Differential associations between childhood maltreatment types and borderline personality disorder from the perspective of emotion dysregulation.

BACKGROUND: Borderline Personality Disorder (BPD) is characterized by pervasive instability in a range of areas including interpersonal relationships, self-image, and affect. Extant studies have consistently identified significant correlations between childhood maltreatment (CM) and BPD. While exploring this CM-BPD link, a number of cross-sectional studies commonly emphasize the role of emotion dysregulation (ED). A better understanding of the associations between BPD and (1) CM and (2) ED are essential in formulating early, effective intervention approaches, and in addressing varied adverse impacts. METHODS: This cross-sectional study analyzed a subset of baseline data collected for a larger community-based longitudinal study. Given that our current focus on CM and ED, only those participants who completed the baseline CM assessment and ED measure (N = 144) were included for the primary analyses. We conducted stepwise multivariate linear models to examine the differential relationships between BPD features, ED, and multiple CM types. A path analysis with latent factors using the structural equation modeling (SEM) method was performed to test the indirect effect from CM to BPD features via ED. RESULTS: Linear regression models revealed that only emotional abuse (relative to other trauma types) was significantly associated with high BPD features. The SEM, by constructing direct and indirect effects simultaneously, showed that (1) ED partially mediated the path from CM to BPD features; and (2) CM played an important role in which the direct effect remained significant even after accounting for the indirect effect through ED. CONCLUSIONS: Our results highlight a most consistent association between emotional abuse and BPD, indicating its unique role in understanding BPD features in the context of CM. Further, shame-related negative appraisal and ED were found critical when examining the association between CM and BPD, possibly providing promising treatment targets for future practices.

A Systematic Review of the Association Between Early Childhood Trauma and Borderline Personality Disorder.

Borderline personality disorder (BPD) is a debilitating clinical disorder associated with adverse impacts on multiple levels. While a high prevalence of childhood trauma has been noted, the ways such trauma impacts the development of BPD symptomatology remain unclear. In this systematic review, the authors examine the literature from 2000 to 2020, focusing on the association between trauma and BPD, and offer a comprehensive synthesis of possible etiological implications related to either one specific or multiple trauma types. In addition, results are analyzed based on commonly tested trauma parameters, including repeated exposure, polytrauma, onset, perpetrators, and gender. The authors also note some limitations in areas of sampling, measurement, causal inference methods, and data analyses. Results of this review point to several parameters of trauma that can be used to inform training for practitioners as well as enhance current interventions.

Trauma, Sleep and Mental Health Problems in Low-Income Young Adults.

Low-income young adults are more likely to have exposure to trauma, which increases risk for mental health problems. Although adequate sleep promotes good health, people with histories of trauma are more likely to have sleep problems. The current study explored whether poor sleep mediated the relationship between trauma exposure and mental health. A sample of 143 low-income 18-24-year-old young adults completed depression, anxiety, and trauma exposure measures and wore sleep monitors for four nights. Structural equation modeling (SEM) was used to examine both direct and indirect effects of variables. Results showed that higher trauma exposure was associated with depression and anxiety. Mean sleep hours per night was fewer than six, far below recommended guidelines for optimal health and functioning. Fewer sleep hours partially mediated the relationship between both trauma exposure and depression and anxiety, and the direct effect from trauma remained significant after adjusting for the partial mediation from sleep.

Psychometrics of an original measure of barriers to providing family planning information: Implications for social service providers.

Social service professionals can face challenges in the course of providing family planning information to their clients. This article reports findings from a study that developed an original 27-item measure, the Reproductive Counseling Obstacle Scale (RCOS) designed to measure such obstacles based conceptually on Bandura's social cognitive theory (1986). We examine the reliability and factor structure of the RCOS using a sample of licensed social workers (N = 197). A 20-item revised version of the RCOS was derived using principal component factor analysis. Results indicate that barriers to discussing family planning, as measured by the RCOS, appear to be best represented by a two-factor solution, reflecting self-efficacy/interest and perceived professional obligation/moral concerns. Implications for practice and future research are discussed.

Cognitive Enhancement Therapy Improves Resting-State Functional Connectivity in Early Course Schizophrenia.

OBJECTIVE: Cognitive remediation is emerging as an effective psychosocial intervention for addressing untreated cognitive and functional impairments in persons with schizophrenia, and might achieve its benefits through neuroplastic changes in brain connectivity. This study seeks to examine the effects of cognitive enhancement therapy (CET) on fronto-temporal brain connectivity in a randomized controlled trial with individuals in the early course of schizophrenia. METHOD: Stabilized, early course outpatients with schizophrenia or schizoaffective disorder (N = 41) were randomly assigned to CET (n = 25) or an active enriched supportive therapy (EST) control (n = 16) and treated for 2 years. Functional MRI data were collected annually, and pseudo resting-state functional connectivity analysis was used to examine differential changes in fronto-temporal connectivity between those treated with CET compared with EST. RESULTS: Individuals receiving CET evidenced significantly less functional connectivity loss between the resting-state network and the left dorsolateral prefrontal cortex as well as significantly increased connectivity with the right insular cortex compared to EST (all corrected p < .01). These neural networks are involved in emotion processing and problem-solving. Increased connectivity with the right insula significantly mediated CET effects on improved emotion perception (z' = -1.96, p = .021), and increased connectivity with the left dorsolateral prefrontal cortex mediated CET-related improvements in emotion regulation (z' = -1.71, p = .052). CONCLUSIONS: These findings provide preliminary evidence that CET, a psychosocial cognitive remediation intervention, may enhance connectivity between frontal and temporal brain regions implicated in problem-solving and emotion processing in service of cognitive enhancement in schizophrenia.

Fronto-Limbic Brain Dysfunction during the Regulation of Emotion in Schizophrenia.

Schizophrenia is characterized by significant and widespread impairments in the regulation of emotion. Evidence is only recently emerging regarding the neural basis of these emotion regulation impairments, and few studies have focused on the regulation of emotion during effortful cognitive processing. To examine the neural correlates of deficits in effortful emotion regulation, schizophrenia outpatients (N = 20) and age- and gender-matched healthy volunteers (N = 20) completed an emotional faces n-back task to assess the voluntary attentional control subprocess of emotion regulation during functional magnetic resonance imaging. Behavioral measures of emotional intelligence and emotion perception were administered to examine brain-behavior relationships with emotion processing outcomes. Results indicated that patients with schizophrenia demonstrated significantly greater activation in the bilateral striatum, ventromedial prefrontal, and right orbitofrontal cortices during the effortful regulation of positive emotional stimuli, and reduced activity in these same regions when regulating negative emotional information. The opposite pattern of results was observed in healthy individuals. Greater fronto-striatal response to positive emotional distractors was significantly associated with deficits in facial emotion recognition. These findings indicate that abnormalities in striatal and prefrontal cortical systems may be related to deficits in the effortful emotion regulatory process of attentional control in schizophrenia, and may significantly contribute to emotion processing deficits in the disorder.

Cognitive Enhancement Therapy Improves Frontolimbic Regulation of Emotion in Alcohol and/or Cannabis Misusing Schizophrenia: A Preliminary Study.

Individuals with schizophrenia who misuse substances are burdened with impairments in emotion regulation. Cognitive enhancement therapy (CET) may address these problems by enhancing prefrontal brain function. A small sample of outpatients with schizophrenia and alcohol and/or cannabis substance use problems participating in an 18-month randomized trial of CET (n = 10) or usual care (n = 4) completed posttreatment functional neuroimaging using an emotion regulation task. General linear models explored CET effects on brain activity in emotional neurocircuitry. Individuals treated with CET had significantly greater activation in broad regions of the prefrontal cortex, limbic, and striatal systems implicated in emotion regulation compared to usual care. Differential activation favoring CET in prefrontal regions and the insula mediated behavioral improvements in emotional processing. Our data lend preliminary support of CET effects on neuroplasticity in frontolimbic and striatal circuitries, which mediate emotion regulation in people with schizophrenia and comorbid substance misuse problems.

Neurocognitive functioning of individuals with schizophrenia: using and not using drugs.

OBJECTIVES: Research on neurocognition in schizophrenia, using modest samples and self-rated assessments, reports drug use contributes to improved rather than impaired cognitive function. We have sought to replicate these findings in a large sample of patients that had their drug-use status confirmed by laboratory assays and evaluated the potential differences in cognitive function between patients with positive and negative results. METHODS: Nine hundred and seventy four schizophrenia patients completed neuropsychological and laboratory tests at screening/baseline of the Clinical Antipsychotic Trials of Intervention Effectiveness study. Radioimmunoassay (RIA) of hair tested for cannabis, cocaine and methamphetamine. RESULTS: Many patients screened positive for drug use (n = 262; 27%), and there were no differences between patients with positive and negative results in terms of cognitive function after adjusting for multiple inference testing, except patients with positive RIA for methamphetamine demonstrated increased processing speed (corrected, P = .024). Moderator models were employed to explore potential subgroup differences in this pattern of results. At low medication dosages, patients with positive RIA for cocaine demonstrated decreased processing speed compared with patients with negative RIA for cocaine (uncorrected, P = .008). And for any other drugs with low psychopathology, patients with positive RIA demonstrated decreased working memory compared with patients with negative RIA (uncorrected, P = .006). CONCLUSIONS: No positive effects of cannabis on cognitive function were observed, and drug use was not associated with improved neurocognition across most of the subgroup characteristics explored in this sample of schizophrenia patients.

Prefrontal cortical dysfunction during visual perspective-taking in schizophrenia.

Schizophrenia is characterized by marked impairments in a broad and diverse array of social-cognitive domains. Fundamental deficits in the ability to visualize and shift to the perspectives of others and the neural networks that support this ability may contribute to many of these impairments. This study sought to investigate deficits in prefrontal brain function and connectivity in patients with schizophrenia during visual perspective-taking, and the degree to which such deficits contribute to higher-order impairments in social cognition. A total of 20 outpatients with schizophrenia and 20 age- and gender-matched healthy volunteers completed a basic, visual perspective-taking task during functional magnetic resonance imaging, along with a behavioral assessment of theory of mind after neuroimaging. Results revealed hypoactivity in the medial prefrontal (anterior cingulate) and orbitofrontal cortices during perspective-taking trials compared to control trials in schizophrenia patients relative to healthy controls. In addition, patients demonstrated significant deficits in negative connectivity between medial prefrontal and medial-temporal regions during perspective-taking, which fully mediated behavioral impairments observed in theory of mind. These findings suggest that disruptions are present in the most fundamental aspects of perspective-taking in schizophrenia, and that these disruptions impact higher-order social information processing.

Commonalities in social and non-social cognitive impairments in adults with autism spectrum disorder and schizophrenia.

Autism spectrum disorder (ASD) and schizophrenia are both conditions that are characterized by impairments in social and non-social cognition, yet commonalities in the magnitude and domains of cognitive deficits across these two conditions remain unclear. This study examined neurocognitive and social-cognitive functioning in 47 outpatients with schizophrenia, 43 verbal adults with ASD, and 24 healthy volunteers. A comprehensive neuropsychological battery assessing processing speed, attention, memory, and problem-solving domains was administered along with a social-cognitive battery of emotion processing. Results demonstrated large and significant impairments in emotion processing and neurocognition relative to healthy individuals in participants with autism (d=-.97 and -1.71, respectively) and schizophrenia (d=-.65 and -1.48, respectively). No significant differences were observed between those with ASD and schizophrenia on any cognitive domain assessed, and the areas of greatest impairment were identical across both disorders and included slowness in speed of processing and an inability to understand emotions. These findings indicate a high degree of similarity in the cognitive challenges experienced by verbal adults with autism and schizophrenia, and the potential need for trans-diagnostic remediation approaches to enhance cognition in these conditions.

Characterizing the longitudinal patterns of substance use among individuals diagnosed with serious mental illness after psychiatric hospitalization.

AIM: To characterize longitudinal patterns of substance use across a large sample of psychiatric patients discharged from inpatient admission, followed for 1-year post-hospitalization. DESIGN: Prospective cohort study. SETTING: Kansas City, MO, USA; Pittsburgh, PA, USA; Worcester, MA, USA. PARTICIPANTS: Eight hundred and one schizophrenia-spectrum (n = 204), bipolar (n = 137) and depressive disorder (n = 460) patients from the MacArthur Violence Risk Assessment Study. MEASUREMENTS: Symptoms, functioning, drug/alcohol use assessed by the Brief Psychiatric Rating Scale, the Global Assessment of Functioning, and substance use interviews. FINDINGS: Patients used alcohol (67.0%; n = 540) and cannabis (30.0%; n = 237) more frequently than other substances up to 30 days before admission, and those with depressive and schizophrenia-spectrum used heroin more than individuals with bipolar (P = 0.023). Post-hospitalization, patients using alcohol (B = -0.15, P < 0.001) and cannabis (B = -0.27, P < 0.001) decreased, but patterns varied across diagnosis and genders. Patients using cannabis decreased at greater rates in depressive and schizophrenia-spectrum compared with bipolar (all P < 0.05), and more men used alcohol (B = 0.76, P < 0.001) and cannabis (B = 1.56, P < 0.001) than women. Cannabis (B = 1.65, P < 0.001) and alcohol (B = 1.04, P = 0.002) were associated with higher symptomatology; cannabis (B = -2.33, P < 0.001) and alcohol (B = -1.45, P = 0.012) were associated with lower functioning. CONCLUSIONS: Substance use is frequent and associated with poor recovery in patients with serious mental illness recently discharged from psychiatric hospitalization. Addiction treatments personalized by diagnosis and gender may be effective for improving outcomes in people with serious mental illness.

Interviewer-perceived honesty as a mediator of racial disparities in the diagnosis of schizophrenia.

OBJECTIVE: African Americans are disproportionately diagnosed as having schizophrenia, and the factors that contribute to this disparity are poorly understood. This study utilized data from the 1995 MacArthur Violence Risk Assessment Study to examine the impact of racial differences in sociodemographic characteristics, clinical presentation, and perceived honesty on disparities in the diagnosis of schizophrenia among African Americans. METHODS: Researchers using structured assessments of diagnostic, sociodemographic, and clinical measures interviewed African Americans (N=215) and whites (N=537) receiving inpatient care for a severe mental illness. The impact of interviewers' perceptions of the participants' honesty on racial disparities in the diagnosis of schizophrenia was assessed. RESULTS: African Americans (45%) were more than three times as likely as whites (19%) to be diagnosed as having schizophrenia. Disparities in sociodemographic and clinical characteristics modestly contributed to disparities in diagnostic rates. In contrast, interviewer-perceived honesty proved to be a significant predictor of racial disparities in schizophrenia diagnoses. After adjustment for perceived honesty, diagnostic disparities between African Americans and whites were substantially reduced. Mediator analyses confirmed that interviewer-perceived honesty was the only consistent mediator of the relationship between race and schizophrenia diagnosis. CONCLUSIONS: Interviewers' perceptions of honesty among African-American participants are important contributors to disparities in the diagnosis of schizophrenia. Clinicians' perceptions of dishonesty among African-American patients may reflect poor patient-clinician relationships. Methods of facilitating a trusting relationship between patients and clinicians are needed to improve the assessment and treatment of persons from minority groups who are seeking mental health care. (Psychiatric Services 63:875-880, 2012; doi: 10.1176/appi.ps.201100388).

A growth curve analysis of emotion dysregulation as a mediator for violence in individuals with and without borderline personality disorder.

Borderline personality disorder (BPD) is characterized by significant interpersonal conflict, however the factors that contribute to violence among this population are not well known. Individuals with BPD and other severe mental illnesses were followed in the community for 30 weeks post-inpatient discharge. Emotion dysregulation data and detailed measures of violence were collected every 10 weeks, along with measures of antisocial characteristics. Latent growth curve analyses were used to depict individual trajectories of emotion dysregulation throughout the course of the study, and the degree to which changes in emotion dysregulation mediated the risk-enhancing effect of BPD on subsequent interpersonal violence was assessed. Results showed that emotion dysregulation is a significant longitudinal mediator of violent behavior among individuals with BPD, and may serve as the primary mechanism that enhances risk for violence among this population. Implications for modifying existing treatment protocols to reduce interpersonal violence in this population are discussed.

Racial Disparities in Mental Health Outcomes After Psychiatric Hospital Discharge Among Individuals With Severe Mental Illness.

Racial disparities in mental health outcomes have been widely documented in non-institutionalized community psychiatric samples, but few studies have specifically examined the effects of race among individuals with the most severe mental illnesses. A sample of 925 individuals hospitalized for severe mental illness were followed for a year after hospital discharge to examine the presence of disparities in mental health outcomes between African American and White individuals diagnosed with a severe psychiatric condition. Results from a series of individual growth curve models indicated that African American individuals with severe mental illness experienced significantly less improvement in global functioning, activation and anergia symptoms, and were less likely to return to work in the year following hospitalization. Racial disparities persisted after adjustment for sociodemographic and diagnostic confounders, and were largely consistent across gender, socioeconomic status, and psychiatric diagnosis. Implications for social work research and practice with minorities with severe mental illness are discussed.

Effects of Severe Mental Illness Education on MSW Student Attitudes About Schizophrenia.

Social work students (n = 60) in a master's-level course on severe mental illness participated in a quasi-experimental study examining the degree to which increased knowledge about and contact with individuals with schizophrenia during the course would impact their attitudes toward people with the disorder. Results revealed significant improvement in student knowledge and general attitudes after the course, and indicated that increased knowledge about schizophrenia was only related to general attitudinal improvement when accompanied by increased personal social contact. Implications for education on severe mental illnesses, and value and attitude development in social work education are discussed.