Personality Disorder Symptoms in Intermittent Explosive Disorder: A Latent Class Analysis.

Intermittent explosive disorder (IED) is characterized by recurrent reactive aggression. IED is associated with significant personality pathology that is suggestive of higher levels of general personality disorder (PD). However, little is known about how personality factors impact the severity and presentation of IED. The present study employed a latent class analysis to assess for distinct PD symptom classes within IED and to evaluate whether these classes differed in terms of severity and behavioral presentation. Statistical and clinical indicators revealed a four-class model, with latent classes distinguished primarily on general levels of PD symptoms (low, moderate, high). However, the two moderate PD symptom classes were distinguished from other classes on avoidant PD. In addition, classes differed in terms of severity and presentation, suggesting important implications for both general PD and avoidant PD comorbidity within IED. Results provide further insight into the heterogeneity within IED and suggest a more nuanced approach in treating this serious condition.

Are Family Factors Differentially Associated with Externalizing Symptoms Among Youth with Perinatally Acquired HIV?

Youth with perinatally-acquired HIV (PHIV) face unique psychosocial stressors. They are at risk for externalizing problems, including symptoms of oppositional defiant disorder, conduct disorder (CD), and attention-deficit/hyperactivity disorder (ADHD), as well as risk-taking behaviors, such as substance use (SU). Although family factors have been differentially associated with externalizing and SU behaviors based on youth sex in prior research, there is a dearth of literature considering these processes among youth with PHIV. Participants included 314 youth with PHIV (M = 12.88 years, SD = 3.08 years; 50.80% male; 85.30% Black or Latinx). Boys exhibited higher levels of ADHD symptoms than girls. Among boys, lower levels of consistency in discipline were associated with higher CD symptoms. Lower levels of family cohesion were associated with higher levels of SU among girls, and higher levels of CD symptoms across youth sex. Findings support the need for family-focused behavioral interventions among youth with PHIV.

Correlates of Informant Discrepancies in Self-Harm Among Youth Involved in Child Protective Services.

Youth involved with child protective services (CPS) are at elevated risk for engaging in self-harm. Participation in interventions or treatments that may reduce youths' self-harm behaviors often depends on the accurate reporting of their self-injurious behaviors. However, informants often disagree on the presence or severity of self-harm engagement, making the identification of youth in need of treatment more challenging. The current study aims to characterize discrepancies between youth and caregiver reports of children's self-harm among a sample of youth with a history of CPS involvement, and to identify factors (e.g., demographics, youth and caregiver psychological impairments, aspects of the caregiving environment) associated with these discrepancies. Participants (N = 258) were drawn from a large, nationally representative sample of youth under the age of 18 (mean age = 13.8) and their caregivers who were investigated by CPS. Multinomial logistic regressions were used to examine correlates of discrepancies in caregiver and youth reports of youth self-harm. Results indicated that 10% of caregiver-child dyads agreed on children's engagement in self-harm. In 33% of cases, only the child reported self-harm and in 57% of cases, only the caregiver reported youth self-harm. Being a biological caregiver, child female sex, higher levels of internalizing symptoms; higher post-traumatic stress disorder (PTSD) symptoms; and greater caregiver alcohol use was associated with a lower likelihood of caregivers reporting self-harm only. Older child age; lower externalizing symptoms; higher PTSD symptoms, and greater levels of caregiver emotional security and structure were linked to lower odds of children reporting self-harm only. These results underscore important factors to consider when assessing self-harm among youth involved with CPS and have potential implications for practice guidelines in this population.

Co-Occurring Conduct Problems and Anxiety: Implications for the Functioning and Treatment of Youth with Oppositional Defiant Disorder.

Conduct problems and anxiety symptoms commonly co-occur among youths with oppositional defiant disorder (ODD); however, how these symptoms influence functioning and treatment outcomes remains unclear. This study examined subtypes based on these co-occurring symptoms in a clinical sample of 134 youths (Mage = 9.67, 36.6% female, 83.6% white) with ODD and the predictive power of these subgroups for youth functioning and psychosocial treatment outcomes. The latent profile analysis (LPA) was used to identify subgroups based on parent- and self-reported conduct problems and anxiety symptoms. Differences among the subgroups in clinician-, parent-, and/or self-reported accounts of symptom severity, school performance, underlying processing known to be impaired across ODD, conduct and anxiety disorders, self-concept, and psychosocial treatment outcomes were examined. Four distinct profiles were identified: (1) Low Anxiety/Moderate Conduct Problems (n = 42); (2) High Anxiety/Moderate Conduct Problems (n = 33); (3) Moderate Anxiety/Moderate Conduct Problems (n = 40); and (4) Moderate Anxiety/High Conduct Problems (n = 19). The Moderate Anxiety/High Conduct Problems group exhibited more severe behavioral problems, greater difficulties with negative emotionality, emotional self-control, and executive functioning; they also demonstrated worse long-term treatment outcomes than the other subgroups. These findings suggest more homogeneous subgroups within and across diagnostic categories may result in a deeper understanding of ODD and could inform nosological systems and intervention efforts.

The frequency of self-reported memory failures is influenced by everyday context across the lifespan: Implications for neuropsychology research and clinical practice.

OBJECTIVE: To investigate the influence of contextual factors on self-reports of cognitive abilities, this study investigated whether the frequency of self-reported memory failures was affected by level of daily busyness (Busyness) and daily routines (Routine) and whether age moderated these relations. The influence of the COVID-19 pandemic on self-reported memory failures also was explored. Method: 902 community-dwelling participants (mean age= 56.98 years; sd= 18.96; range: 22-97 years) completed self-report questionnaires. Multiple linear regressions examined predictors of the frequency of retrospective (RM) and prospective memory (PM) failures and interactions with age. A pilot measure of the Influence of the Pandemic was added in secondary analyses. Results: Frequency of PM failures was significantly predicted by Age, Busyness, and Routine, such that people who were younger and those with busier and less routine activities reported more frequent PM failures. Frequency of RM failures was significantly predicted by Busyness, and the Age × Busyness and Age × Routine interactions. Busyness was associated with more frequent RM failures for people of all ages, but the effect was stronger for younger people. By contrast, more routine daily schedules were associated with fewer RM failures only for older people. PM/RM failures were predicted by the Influence of the Pandemic in exploratory analyses. Conclusions: Self-reports of cognitive abilities are influenced by contextual factors in adults of all ages. Contextual factors, including everyday task demands, daily routines, and acute stressors that disrupt daily activities, should be considered when interpreting self-reports of cognitive abilities in research and clinical practice settings.

Community Violence Exposure and Generalized Anxiety Symptoms: Do Callous-Unemotional Behaviors Moderate this Relation Among Urban Youth?

Community violence exposure (CVE; i.e., direct victimization and witnessed violence) is a major public health concern among youth who reside in low income, urban neighborhoods, who tend to experience CVE chronically and disproportionately. Frequent CVE is associated with generalized anxiety disorder (GAD) symptoms, such as persistent or excessive worry and difficulty concentrating. However, not all youth experiencing CVE exhibit such symptoms. One understudied factor that may moderate this relation is callous-unemotional (CU) behaviors (e.g., behaviors consistent with lack of guilt, low levels of empathy). CU behaviors are associated with lower levels of responsiveness to contextual processes; as such, CU behaviors may be associated with lower levels of GAD symptoms in the context of CVE. However, little research considers CU behaviors and GAD symptoms concurrently. To address this gap, the present study examined associations among witnessed and direct CVE, CU behaviors, and GAD symptoms among low-income, urban youth (N = 104, 50% male, Mage = 9.93 ± 1.22 years old, 95% African-American/Black). Multiple regression analyses indicated teacher-reported CU behaviors moderated the relations between CVE and caregiver-reported GAD symptoms. Post-hoc probing revealed that among youth with higher levels of CVE, higher levels of CU behaviors were associated with elevated GAD symptoms compared to their peers with lower levels of CU behaviors. Youth with lower levels of CU behaviors evidenced moderate levels of GAD symptoms regardless of their levels of CVE. Thus, low-income, urban youth who experience elevated levels of CVE may be at increased risk for co-occurring GAD and CU symptoms.

Preoperative cognition predicts clinical stroke/TIA and mortality after surgical aortic valve replacement in older adults.

Stroke and death remain risks of surgical aortic valve replacement (SAVR). Preoperative cognitive screeners repeatedly show that reduced scores predict postoperative outcome, but less is known about comprehensive neuropsychological measures predicting risk. This study had two aims: 1) investigate whether preoperative cognitive measures predicted postoperative clinical stroke/transient ischemic attack (TIA) and mortality in older adults undergoing SAVR, and 2) identify the best predictors within a comprehensive cognitive protocol. A total of 165 participants aged 65 + with moderate-to-severe aortic stenosis completed a comprehensive cognitive test battery preoperatively. Postoperative stroke evaluations were conducted by trained stroke neurologists preoperatively and postoperatively, and mortality outcomes were obtained by report and records. Logistic regressions were conducted to evaluate preoperative cognitive predictors of clinical stroke/TIA within 1 week of surgery and mortality within 1 year of surgery. Multivariate models showed measures of delayed verbal memory recall (OR = 0.86; 95% CI 0.74-0.99) and visuospatial skills (OR = 0.95; 95% CI 0.90-1.01) predicted clinical stroke/TIA within 1 week of surgery, R2 = .41, p < .001, ƒ2 = .69. Measures of naming ability (OR = 0.88; 95% CI 0.80-0.96), verbal memory recall (OR = 1.23; 95% CI 0.99-1.51), visual memory recall (OR = 0.90; 95% CI 0.80-1.00), medical comorbidities (OR = 1.71; 95% CI 1.22-2.65), and sex (OR = 2.39; 95% CI 0.90-7.04) were significant predictors of death within 1 year of surgery, R2 = .68, p < .001, ƒ2 = 2.12. Preoperative cognitive measures reflecting temporal and parietal lobe functions predicted postoperative clinical stroke/TIA within 1 week of SAVR and mortality within 1 year of SAVR. As such, cognitive measures may offer objective and timely indicators of preoperative health, specifically vulnerabilities in cerebral hypoperfusion, which may inform intervention and/or intensive postoperative monitoring and follow-up after SAVR.

A latent class analysis of intermittent explosive disorder symptoms.

Intermittent explosive disorder (IED), the sole diagnosis in the DSM-5 for which the cardinal symptom is recurrent affective aggressive outbursts, is a common and substantially impairing disorder. IED is also associated with several cognitive and affective impairments. However, little is known about the heterogeneity of the disorder and how this may correspond to aggression severity and related adverse outcomes. The current study employed a latent class analysis (LCA) among individuals diagnosed with lifetime DSM-5 IED to derive distinct subgroups that differed in the quality and/or frequency of cognitive-affective symptoms. These subgroups were then externally validated on a number of adverse outcomes. Statistical and clinical indicators supported a four-class model. Classes were distinguished mainly by the level of emotion dysregulation participants endorsed, with two moderate emotion dysregulation classes differing on their emotional information processing and impulsive tendencies. The external validation analysis revealed that classes differed in terms of various adverse outcomes (e.g., interpersonal problems, life satisfaction, suicide risk). Overall, the present study suggests distinct cognitiveaffective symptom profiles among those with IED that differ meaningfully with regard to risk for adverse outcomes. These findings provide evidence of the heterogeneity within IED and may suggest a more personalized therapeutic approach to patients with IED.

Early Childhood Behavioral and Academic Antecedents of Lifetime Opioid Misuse among Urban Youth.

OBJECTIVE: Opioid misuse has become an epidemic in the United States. In the present study, we examine potential malleable early childhood predictors of opioid misuse including whether childhood achievement, aggressive behavior, attention problems, and peer social preference/likability in first grade predicted opioid misuse and whether these relationships differed depending on participant sex. METHOD: Data are drawn from three cohorts of participants (N = 1,585; 46.7% male) recruited in first grade as part of a series of elementary school-based, universal preventive interventions conducted in a Mid-Atlantic region of the US. In first grade, participants completed standardized achievement tests, teachers reported on attention problems, and peers nominated their classmates with respect to their aggressive behavior and social preference/likability. At approximately age 20, participants reported on their misuse of opioids defined as lifetime use of heroin or misuse of prescription opioids. RESULTS: Higher levels of peer nominations for aggressive behavior in first grade predicted a greater likelihood of opioid misuse. An interaction between participant sex and attention problems was observed such that females higher in attention problems were more likely to misuse opioids, particularly prescription opioids, than females lower in attention problems. An interaction was also found between participant sex and peer likability such that males lower in peer-nominated likability were more likely to misuse opioids relative to males higher in likability. CONCLUSION: Given the malleable nature of attention problems, aggression, and social skills in early childhood, prevention programs that target these behaviors during this developmental period may attenuate risk for opioid misuse.

Latent Profile Analysis of Cognition in a Non-Demented Diverse Cohort: A Focus on Modifiable Cardiovascular and Lifestyle Factors.

BACKGROUND: Cognitively-defined subgroups are well-documented within neurodegeneration. OBJECTIVE: We examined such profiles in diverse non-demented older adults and considered how resulting subgroups relate to modifiable factors associated with neurodegeneration. METHODS: 121 non-demented (MMSE = 28.62) diverse (46%non-Latino Black, 40%non-Latino White, 15%Latino) community-dwelling adults (age = 67.7 years) completed cognitive, cardiovascular, physical activity, and diet evaluations. Latent profile analyses (LPA) employed six cognitive scores (letter fluency, letter-number sequencing, confrontational naming, 'animal' fluency, list-learning delayed recall, and recognition discriminability) to characterize cognitively-defined subgroups. Differences between resulting subgroups on cardiovascular (composite scores of overall health; specific health components including fasting blood levels) and lifestyle (sedentary behavior; moderate-to-vigorous physical activity; Mediterranean diet consumption) factors were examined using ANCOVAs adjusting for relevant confounders. RESULTS: Based on sample means across cognitive scores, LPA resulted in the following cognitive subgroups: 1) high-average cognition, 55%non-Latino White and 64%female participants; 2) average cognition, 58%non-Latino Black and 68%male participants; 3) lower memory, 58%non-Latino Black participants; and 4) lower executive functioning, 70%Latinos. The high-average subgroup reported significantly higher Mediterranean diet consumption than the average subgroup (p = 0.001). The lower executive functioning group had higher fasting glucose and hemoglobin A1c than all other subgroups (p-values<0.001). CONCLUSION: LPA revealed two average subgroups reflecting level differences in cognition previously reported between non-Latino White and Black adults, and two lower cognition subgroups in domains similar to those documented in neurodegeneration. These subgroups, and their differences, suggest the importance of considering social determinants of health in cognitive aging and modifiable risk.

Family Contextual Factors are Differentially Associated with Depressive Symptoms among Boys and Girls with Perinatally Acquired HIV.

Youth with perinatally acquired HIV (PHIV) are at risk for depressive symptoms, which are associated with a range of adverse outcomes. Although family contextual factors associated with depressive symptoms differ among boys and girls without PHIV, it is unclear whether this is also the case among youth with PHIV. Participants included 314 youth with PHIV (M = 12.88, SD = 3.08 years old; 51% male; 85% Black/Latinx) and their caregivers. Higher levels of caregivers' own depressive symptoms, caregiver-child detachment, and family conflict were associated with higher levels of caregiver-reported youth depressive symptoms. Less consistent discipline was associated with higher levels of youth-reported depressive symptoms. Higher youth-reported depressive symptoms were associated with greater family cohesion among boys and greater caregiver detachment among girls. Consideration of contextual variables is essential for interventions for depressive symptoms among youth with PHIV, but attention to sex differences with family contextual factors is also important.

Community Violence Exposure and Youth Aggression: The Moderating Role of Working Memory.

Community violence exposure (CVE) is associated with aggression among youth, particularly those who reside in low-income, urban neighborhoods. However, not all youth who experience CVE exhibit aggression. Working memory (WM) difficulties may interfere with attributions or retrieval of nonaggressive responses, suggesting that individual differences in WM may contribute to proactive and/or reactive aggression among youth who experience CVE. Participants were 104 low-income, urban youth (M = 9.92 ± 1.22 years old; 50.5% male; 95% African American). Youth reported on frequency of direct victimization and witnessing of violence in the community and completed two WM tasks. Teachers reported on youth proactive and reactive aggression. WM moderated the relation between direct victimization and proactive and reactive aggression, and between witnessing violence and reactive aggression. Among youth reporting less frequent victimization and witnessing, lower WM was associated with higher levels of proactive and reactive aggression. Among youth reporting more frequent direct victimization, lower WM was associated with higher levels of proactive aggression. Proactive and reactive aggression levels were similar among youth reporting more frequent witnessing regardless of WM levels. WM represents a potential target for early identification and intervention efforts to reduce reactive and proactive aggression among low-income, urban youth who are at elevated risk for CVE.

Informant Reporting in Mild Cognitive Impairment: Sources of Discrepancy on the Functional Activities Questionnaire.

OBJECTIVE: Relative to dementia, little is known about informant bias in mild cognitive impairment (MCI). We investigated the influence of informant demographic and relational characteristics on reports of everyday functioning using the Functional Activities Questionnaire (FAQ). METHOD: Four thousand two hundred eighty-four MCI participants and their informants from the National Alzheimer's Coordinating Center Uniform Data Set were included. Informants were stratified according to cohabitation, relationship, visit frequency, race/ethnicity, education, and sex. Informant-rated Mean FAQ score was compared across these groups using univariate general linear model analyses and post hoc tests. Interactions were tested between informant variables. The predictive contribution of informant variables to FAQ score was explored using hierarchical linear regression. Analyses covaried for participant cognition using a cognitive composite score, and for participant age, sex, and depression. RESULTS: After controlling for participant cognition, depression, age, and sex, informant-rated FAQ scores varied significantly across all informant variables (p's < .005, ηp2's ≤ .033) except sex and visit frequency. FAQ scores were higher (more impaired) among informants who cohabitate with the participant, among paid caregivers, spouses, and adult children, and among informants with higher levels of education. Scores were lowest (less impaired) among Black/African American informants as compared to all other racial/ethnic groups. CONCLUSIONS: Demographic and relational characteristics of informants influence the perception and reporting of instrumental activities of daily living in adults with MCI. As everyday functioning is crucial for differential diagnosis and treatment outcome measurement, it is important to be aware of sources of informant report discrepancies.

Symptom Profiles of CD and ODD Among Youth With Perinatally Acquired HIV.

OBJECTIVE: Youth with perinatally acquired human immunodeficiency virus (PHIV) face increased risk for conduct disorder (CD) and oppositional defiant disorder (ODD) symptoms, and heterogeneous findings indicate that there may be subgroups of youth with PHIV differing in the quality and/or frequency of symptoms. The present study examined symptom profiles of CD and ODD among youth with PHIV and whether profiles differed in terms of parent-child and family correlates. METHODS: Participants included 314 youth with PHIV, aged 6-17 years (M = 12.88 years, SD = 3.08; 51% male; 85% Black or Latinx), and their caregivers who were recruited from 29 clinics in the US involved in the International Maternal Pediatrics Adolescent AIDS Clinical Trials (IMPAACT) Group's P1055 study. Caregivers reported on youth CD and ODD symptoms, parent-child interactions, and family environment. RESULTS: Latent class analysis indicated that a four-class model (i.e., moderate CD/high ODD, high ODD, moderate ODD, low CD/ODD) best fit the data. Ancillary analyses to validate these classes revealed differences for family cohesion and conflict; and child-centeredness, detachment, guilt-induced control, and consistency in parent-child interactions. The low CD/ODD class generally differed from other classes with additional differentiation between some higher risk profiles. CONCLUSIONS: Findings suggest that homogeneous classes of CD/ODD symptoms can be identified among youth with PHIV, and these profiles differ in terms of family processes, consistent with previous work among chronically ill youth.

Does Negative Emotional Reactivity Moderate the Relation between Contextual Cohesion and Adolescent Well-Being?

Although well-being is a chief indicator of positive mental health, much research has neglected to consider individual-specific and contextual factors that may promote this important outcome among youth. To address this gap, we examined whether neighborhood and family social cohesion are associated with well-being among youth varying in negative emotional reactivity, and whether findings were consistent with the diathesis-stress or differential susceptibility hypothesis. Participants were assessed at 3 time points: Time 1 (N = 775, M age = 10.95 ± 0.88 years; 71% male); Time 2 (n = 660, M age = 12.99 ± 0.95 years); and Time 3 (n = 633, M age = 15.50 ± 0.56 years). At Time 1, caregivers reported on family and neighborhood cohesion. Youth reported on their negative emotional reactivity at Time 2 and well-being at Time 3. Negative emotional reactivity moderated the relation between family cohesion and well-being. Among youth higher in negative emotional reactivity, lower family cohesion was associated with lower levels of well-being compared to higher family cohesion. Youth higher and lower in emotional reactivity evidenced similar levels of well-being when exposed to higher family cohesion. The findings thus support the diathesis-stress model, suggesting that less cohesive families may contribute to reduced happiness and well-being, particularly among youth with higher negative emotional reactivity.

Short communication: Diffusion tensor anisotropy in the cingulate in borderline and schizotypal personality disorder.

Despite considerable phenomentological differences between borderline personality disorder (BPD) and schizotypal personality disorder (SPD), research increasingly provides evidence that some BPD symptoms overlap with SPD symptoms (e.g., disturbed cognitions). We examined the cingulate, a brain region implicated in the pathophysiology of both disorders, to determine similarities/differences between the groups, and similarities/differences from healthy controls (HC's). 3T structural and diffusion tensor magnetic resonance imaging scans were acquired in BPD (n = 27), SPD (n = 32), HC's (n = 34). Results revealed that BPD patients exhibited significantly lower FA in posterior cingulate white matter compared to HC's (p = 0.04), but SPD patients did not.

Heterogeneity of Informant-Reported Functional Performance in Mild Cognitive Impairment: A Latent Profile Analysis of the Functional Activities Questionnaire.

Heterogeneity of subtle functional difficulties in mild cognitive impairment (MCI) remains poorly understood. We characterized patterns of informant reports of functional abilities among participants with MCI and the relation between functional ability pattern and cognitive abilities and subsequent decline. Data from 4,273 MCI participants from the National Alzheimer's Coordinating Center (NACC) Uniform Data Set (UDS) were included in latent profile analyses (LPA) of informant responses on the Functional Activities Questionnaire (FAQ). Profiles from the best fitting model were compared on demographic, clinical, and cognitive variables. The best fitting model supported three profiles varying by level and type of difficulty: intact function (n = 3,299), intermediate (n = 769), and high ratings of difficulty (n = 205). For the Intermediate profile, items related to finances, remembering dates, and travel were rated as most difficult. The High Ratings profile also had elevated ratings on the meal preparation item. Participants with either the Intermediate or High Ratings profile demonstrated a three-fold increase in conversion to dementia as compared to participants with the Intact profile. Demographically, the Intact profile was younger and consisted of a higher proportion of minorities. On cognitive tests, the Intact profile showed the best performance, and the Intermediate profile performed comparably to or better than the High Ratings profile. There is meaningful heterogeneity in informant ratings of function in MCI, though individuals with MCI whose informants report even intermediate-level functional difficulties are more likely to progress to dementia, suggesting that even subtle functional difficulties place individuals at higher risk for future decline.

Profiles of caregiving behaviors among children and adolescents with perinatally acquired HIV.

Although parenting behaviors are widely considered an important factor in the adjustment of children and adolescents with chronic physical health needs, few studies have addressed this topic as it pertains to youth with perinatally-acquired human immunodeficiency virus (PHIV). We examined profiles of child-centeredness, control through guilt, consistent discipline, and detachment, and whether these profiles differed in terms of parent- and youth-reported psychiatric disorder symptoms in a cohort of HIV infected youth (N = 314). Latent profile analyses of caregiving behaviors were conducted separately for children (6-12 years) and adolescents (13-18 years). Two profiles were identified among children: (a) moderate caregiving (87%, n = 130) and (b) high detachment caregiving (13%, n = 19), and three profiles were identified among adolescents: (a) moderate caregiving (55%, n = 88), (b) high detachment caregiving (19%, n = 30), and (c) high control through guilt caregiving (26%, n = 42). The high detachment and high control through guilt caregiving profiles displayed higher levels of parent-and youth-reported symptoms than the moderate caregiving profile. These findings suggest that caregiver behaviors of PHIV youth vary as a function of children's developmental period and differ in terms of youth psychological symptoms.