Multifamily therapy for young people with OCD: An acceptability and satisfaction study.

Individual cognitive-behavioral therapy (CBT) is the recommended first-line psychological treatment for young people with obsessive-compulsive disorder (OCD), with good outcomes. However, because some young people only partially respond to CBT, it is necessary to improve treatment outcomes. This is the first study to explore the acceptability and satisfaction of a new multifamily therapy (MFT). Three groups were attended by 16 young people with OCD, their parents, and siblings. Parents and young people completed questionnaires and focus groups. Thematic analysis was applied to transcripts of focus groups. The majority of young people and parents (93.9%) were satisfied or very satisfied. Thematic analysis identified benefits, including increased understanding of OCD, support from the group, and a feeling of not being alone. Further research is required to establish the group's effectiveness on OCD symptom severity and to identify the factors that MFT addresses. MFT shows promise as an acceptable and satisfactory treatment.

Group cognitive remediation therapy for children and adolescents in intensive day-patient treatment for anorexia nervosa: a feasibility study.

BACKGROUND: Cognitive Remediation Therapy (CRT) is an adjunct treatment targeting set-shifting (SS) and weak central coherence (CC) thought to play a role in maintaining anorexia nervosa (AN). This study aimed to test the feasibility of brief group CRT for young people with AN in a day-patient setting using neuropsychological assessment of SS and CC. It also explored the benefit for young people with Autism Spectrum Disorder (ASD) features. METHODS: Twenty female day-patients (12-18 years) with AN or Atypical AN completed neuropsychological assessment of SS (using the Wisconsin Card Sorting Task and the Brixton Spatial Anticipation Test) and of CC (using the Rey Osterrieth Complex Figures Task) pre and post 4 sessions of group CRT. Baseline ASD features and weight change pre and post were measured. Feasibility was assessed regarding the recruitment process, intervention feedback, suitability of neuropsychological assessment measures, and effect sizes. RESULTS: Study uptake was 95%, intervention retention was 91%, and group CRT was rated as acceptable. Medium to large effect size improvements were found across measures of SS (dz = 0.44 to dz = 0.90) and medium size improvements found in CC (dz = 0.59). Young people with ASD features showed smaller to similar size improvements in SS and larger improvements in CC. There was a moderate (not significant) correlation with level of weight restoration. CONCLUSIONS: Important study parameters have been estimated in order to plan a future definitive trial of brief group CRT in a day-patient setting using neuropsychological assessment. These findings also have implications for the use of brief group CRT in young people with ASD features.

Focus on anorexia nervosa: modern psychological treatment and guidelines for the adolescent patient.

Anorexia nervosa is a serious condition associated with high mortality. Incidence is highest for female adolescents, and prevalence data highlight a pressing unmet need for treatment. While there is evidence that adolescent-onset anorexia has relatively high rates of eventual recovery, the illness is often protracted, and even after recovery from the eating disorder there is an ongoing vulnerability to psychosocial problems in later life. Family therapy for anorexia in adolescence has evolved from a generic systemic treatment into an eating disorder-specific format (family therapy for anorexia nervosa), and this approach has been evidenced as an effective treatment. Individual treatments, including cognitive behavioral therapy, also have some evidence of effectiveness. Most adolescents can be effectively and safely managed as outpatients. Day-patient treatment holds promise as an alternative to inpatient treatment or as an intensive program following a brief medical admission. Evidence is emerging of advantages in detecting and treating adolescent anorexia nervosa in specialist community-based child and adolescent eating-disorder services accessible directly from primary care. Limitations and future directions for modern treatment are considered.

Set shifting in children and adolescents with anorexia nervosa: an exploratory systematic review and meta-analysis.

OBJECTIVE: Set shifting inefficiencies in adults with anorexia nervosa (AN) are established, however the neurocognitive profile of children and adolescents with AN is less clear. This study aimed to provide a review of the literature. METHOD: Electronic databases were used to search for manuscripts. RESULTS: Meta-analysis was performed on seven studies using two neuropsychological tests (Trail Making Task, TMT; Wisconsin Card Sorting Task, WCST). The mean difference in outcome between AN and healthy control (HC) groups was standardized by calculating Cohen's d. Meta-analysis of TMT studies showed a nonsignificant negative, pooled standardized mean difference of -0.005 (95% C.I. -0.416 to 0.406, z = 0.02, p = .98). WCST studies revealed a nonsignificant pooled effect size of d = 0.196 (95% C.I. -0.091-0.483, z = 1.34, p = .18). Studies which did not allow for a calculation of effect size typically showed a nonsignificant, worse performance by the AN groups. DISCUSSION: The inefficiencies in set shifting that are apparent in the adult AN literature do not appear to be as pronounced in children. This may suggest that set shifting difficulties in adult AN are the result of starvation or indicative of longer duration of illness. Larger studies are needed to confirm these impressions.

Brief report: a family risk study exploring bipolar spectrum problems and cognitive biases in adolescent children of bipolar parents.

Children of parents with bipolar disorder are at increased risk of bipolar spectrum diagnoses. This cross-sectional study explores cognitive factors in the prediction of vulnerability to bipolar disorder. Adolescents at high-risk (with a parent with bipolar disorder; n = 23) and age and gender matched adolescents (n = 24) were recruited. Parent and adolescent diagnoses were evaluated (SCID and SADS-L). Adolescents completed self-report measures assessing attributional style (ASQ), appraisal of hypomania-relevant experiences (HIQ), and hypomanic personality/temperament (HPS). Despite limitations in the power of the study, significantly more adolescents at high-risk for disorder received bipolar spectrum diagnoses. Groups did not differ in attributional style, hypomanic temperament or appraisals of hypomania-relevant experiences. A trend in ASQ results and general implications are discussed. The current study suggests that familial risk of bipolar disorder is not inevitably associated with cognitive biases in adolescence.

Parental communication style and family relationships in children of bipolar parents.

OBJECTIVES: To examine relationships between parental communication styles and family environment in parents with bipolar disorder (BD) and their children (CBP). METHODS: On measures of parental communication styles and family environment, 20 BD parents and their 23 children (CBP) were compared to controls. Children completed a current mood measure. RESULTS: BD parents endorsed more negative communication styles and were less expressive than controls. CBP presented with more current or lifetime mood disorder diagnoses than control children (CC). Current depressive mood was associated with different perceptions of family environment for both CBP and CC. CONCLUSIONS: This familial high risk design indicated differences in family environment, parenting style, and in children of bipolar parents' perception of their family environment as it relates to their current mood.