Lay counselors: Thoughts on the crossing of ecological frameworks and the use of lay counselors in the scale up of early infant mental health interventions.

The recent call for the scale-up of evidence-based early childhood development interventions, in lower and middle-income countries and for minority groups in high-income countries, has seen numerous suggestions to train greater numbers of lay mental health workers to fulfill these functions. While studies have found that concepts from developed country settings, such as attachment, parental sensitivity, and containment, find purchase and relevance within developing settings, the management of contextual and cultural factors and the tensions of cultural interfacing in the rollout of these programs in developing country settings require consideration. Drawing on the experiences of two successful South African mother-infant home-visiting programs as examples, this article discusses some of the challenges in provision of attachment-based infant mental health programs and highlights the need for careful consideration of a number of factors pertaining to the recruitment, supervision, and management of lay mental health workers before large-scale rollout is conducted.

La reciente llamada para aumentar proporcionalmente las intervenciones sobre el desarrollo en la niñez con base en la evidencia, en países de ingresos más bajos e ingresos medios, y en el caso de grupos minoritarios en países de ingresos altos, ha visto numerosas sugerencias para entrenar un mayor número de trabajadores laicos de la salud mental que puedan realizar estas funciones. Mientras que los estudios han concluido con que conceptos provenientes de ambientes de países desarrollados, tales como afectividad, sensibilidad de los padres y contención, venden y encuentran relevancia dentro de escenarios de países en desarrollo, el tratamiento de factores contextuales y culturales y las tensiones de interconexiones culturales en la introducción de estos programas en escenarios de países en desarrollo requiere consideración. Utilizando las experiencias de dos exitosos programas madre-infante de visitas a casa en Sudáfrica como ejemplos, este artículo discute algunos de los retos en cuanto a la provisión de programas de salud mental infantil basados en la afectividad y subraya la necesidad de la cuidadosa consideración de un número de factores referentes al reclutamiento, supervisión y dirección de trabajadores laicos de la salud mental antes de que se lleve a cabo la introducción a gran escala.

L'injonction récente à intensifier les programmes d'intervention de développement de la petite enfance fondés sur des données probantes, dans des pays en voie de développement, et pour des groupes minoritaires dans les pays riches, a déclenché de nombreuses suggestions de formation d'un plus grand nombre de travailleurs laïcs de la santé mentale afin de remplir ces fonctions. Alors que des études ont établi que des concepts issus de contextes de pays développés, tels que l'attachement, la sensibilité parentale et la discipline trouvent acquisition et raison d'être au sein de contextes développés, la gestion de facteurs contextuels et culturels et les tensions d'interfaçage culturel dans le lancement de ces programmes dans des contextes de pays en voie de développement exigent d'être considérées et tenues en compte. A partir des expériences de deux programmes de Visite à Domicile Mère-Nourrisson Sud- Africains comme exemples, cet article discute certains des défis dans la prestation de programmes de Santé Mentale du Nourrisson basés sur l'attachement et met en lumière le besoin de considération attentionnée à un nombre de facteurs ayant trait au recrutement, à la supervision et à la gestion de travailleurs laïcs de santé avant que soit lancée une version à grande échelle du programme.

THE POSITIVITY OFFSET THEORY OF ANHEDONIA IN SCHIZOPHRENIA.

Prior studies have concluded that schizophrenia patients are not anhedonic because they do not report reduced experience of positive emotion to pleasant stimuli. The current study challenged this view by applying quantitative methods validated in the Evaluative Space Model of emotional experience to test the hypothesis that schizophrenia patients evidence a reduction in the normative "positivity offset" (i.e., the tendency to experience higher levels of positive than negative emotional output when stimulus input is absent or weak). Participants included 76 schizophrenia patients and 60 healthy controls who completed an emotional experience task that required reporting the level of positive emotion, negative emotion, and arousal to photographs. Results indicated that although schizophrenia patients evidenced intact capacity to experience positive emotion at high levels of stimulus input, they displayed a diminished positivity offset. Reductions in the positivity offset may underlie volitional disturbance, limiting approach behaviors toward novel stimuli in neutral environments.

A Developmental Perspective on Social-Cognition Difficulties in Youth at Clinical High Risk for Psychosis.

LEARNING OBJECTIVES: After participating in this activity, learners should be better able to:• Evaluate the evolution of social cognitive abilities as a developmental process• Assess the evidence regarding social cognition difficulties in youth at clinical high risk for psychosisIndividuals at clinical high risk (CHR) for psychosis exhibit a broad range of difficulties, including impaired social cognition, which may represent a target for early identification and intervention. Several studies have examined various domains of social cognition in CHR individuals. Most focus on adolescent and young adult populations, but given the accumulating evidence that impairment exists before the onset of psychotic disorders, it is critically important to begin to look for these risk markers in younger children. The present article reviews 25 studies on CHR that examine any of the following four domains of social cognition: emotion processing, theory of mind, social perception, or attribution bias. Eligible studies were identified through a comprehensive literature search, conducted using electronic databases, including PubMed/MEDLINE and PsycINFO, and combinations of key social-cognition and CHR search terms. Despite some mixed results, the existing literature establishes that CHR individuals display social-cognitive impairment, though it remains unclear as to how and when that impairment develops. Thus, by using the literature on social cognition in typically developing children as a model and reference, and by looking at the evolution of social-cognitive abilities as a developmental process, our review presents a valuable new perspective that indicates the necessity of further investigation in younger, at-risk populations. Implications for treatment and future research are discussed.

A Review of Anticipatory Pleasure in Schizophrenia.

PURPOSE OF REVIEW: Anhedonia, traditionally defined as a diminished capacity to experience pleasure, has long been considered a core symptom of schizophrenia. However, recent research calls into question whether individuals with schizophrenia are truly anhedonic, suggesting intact subjective and neurophysiological response to rewarding stimuli in-the-moment. Despite a presumably intact capacity to experience pleasure, people with schizophrenia still engage in fewer reward-seeking behaviors. This discrepancy has been explained as a dissociation between "liking" and "wanting", with dopaminergic and prefrontal influences on incentive salience leading hedonic responses to not effectively translate into motivated behavior. In the current review, the literature on a key aspect of the wanting deficit is reviewed, anticipatory pleasure. RECENT FINDINGS: Results provide consistent evidence for impairment in some aspects of anticipatory pleasure (e.g., prospection, associative learning between reward predictive cues and outcomes), and inconsistent evidence for others (e.g., anticipatory affect and affective forecasting). SUMMARY: Mechanisms underlying anticipatory pleasure abnormalities in schizophrenia are discussed and a new model of anticipatory pleasure deficits is proposed. Findings suggest that anticipatory pleasure may be a critical component of impairments in wanting that impact motivated behavior in schizophrenia.

Avolition, Negative Symptoms, and a Clinical Science Journey and Transition to the Future.

The concepts and investigations reviewed above suggest the following * Schizophrenia is a clinical syndrome that can be deconstructed into meaningful domains of psychopathology. * Individual patients vary substantially on which domains are present as well as severity. * Negative symptoms are common in persons with schizophrenia, but only primary negative symptoms are a manifestation of schizophrenia psychopathology in the "weakening of the wellsprings of volition" sense that Kraepelin described. * The failure to distinguish primary from secondary negative symptoms has profound consequences as viewed in the vast majority of clinical trials that report negative symptom efficacy without regard for causation and without controlling for pseudospecificity. * Schizophrenia is now broadly defined with positive psychotic symptoms, and a subgroup with primary negative symptoms is a candidate disease entity. * Evidence of negative symptoms as a taxon supports the separate classification of persons with primary negative symptoms. * Negative symptoms are an unmet therapeutic need. * Two factors best define the negative symptom construct and these may have different pathophysiological and treatment implications. * The avolitional component may not be based on a diminished capacity to experience pleasure, but difficulty using mental representations of affective value to guide decision-making and goal-directed behavior. Part II in this volume by Strauss et al. will address the range of laboratory-based investigations of negative symptoms, clarify current hypotheses and theories concerning negative symptom pathology, and address future directions for negative symptom research and clinical care.

Default Mode Network Functional Reorganization During Early Abstinence in Polysubstance-Using Emerging Adults Treated for Opioid Dependence.

This study examined default mode network connectivity within the first 30 days of abstinence in emerging adults entering treatment for opioid dependence. There were significant associations between abstinence duration and coupling strength with brain regions within and outside of the network.

Avolition in schizophrenia is associated with reduced willingness to expend effort for reward on a Progressive Ratio task.

The current study examined whether effort-cost computation was associated with negative symptoms of schizophrenia (SZ). Participants included outpatients diagnosed with SZ (n=27) and demographically matched healthy controls (n=32) who completed a Progressive Ratio task that required incrementally greater amounts of physical effort to obtain monetary reward. Breakpoint, the point at which participants was no longer willing to exert effort for a certain reward value, was examined as an index of effort-cost computation. There were no group differences in breakpoint for low, medium, or high value rewards on the Progressive Ratio task. However, lower breakpoint scores were associated with greater severity of avolition and anhedonia symptoms in SZ patients. Findings provide further evidence that impaired effort-cost computation is linked to motivational abnormalities in SZ.

Using Implicit and Explicit Measures to Predict Nonsuicidal Self-Injury Among Adolescent Inpatients.

OBJECTIVE: To examine the use of implicit and explicit measures to predict adolescent nonsuicidal self-injury (NSSI) before, during, and after inpatient hospitalization. METHOD: Participants were 123 adolescent psychiatric inpatients who completed measures at hospital admission and discharge. The implicit measure (Self-Injury Implicit Association Test [SI-IAT]) and one of the explicit measures pertained to the NSSI method of cutting. Patients were interviewed at multiple time points at which they reported whether they had engaged in NSSI before their hospital stay, during their hospital stay, and within 3 months after discharge. RESULTS: At baseline, SI-IAT scores differentiated past-year self-injurers and noninjurers (t121 = 4.02, p < .001, d = 0.73). These SI-IAT effects were stronger among patients who engaged in cutting (versus noncutting NSSI methods). Controlling for NSSI history and prospective risk factors, SI-IAT scores predicted patients' subsequent cutting behavior during their hospital stay (odds ratio (OR) = 8.19, CI = 1.56-42.98, p < .05). Patients' explicit self-report uniquely predicted hospital-based and postdischarge cutting, even after controlling for SI-IAT scores (ORs = 1.82-2.34, CIs = 1.25-3.87, p values <.01). Exploratory analyses revealed that in specific cases in which patients explicitly reported low likelihood of NSSI, SI-IAT scores still predicted hospital-based cutting. CONCLUSION: The SI-IAT is an implicit measure that is outcome-specific, a short-term predictor above and beyond NSSI history, and potentially helpful in cases in which patients at risk for NSSI explicitly report that they would not do so in the future. Ultimately, both implicit and explicit measures can help to predict future incidents of cutting among adolescent inpatients.

Teaching pediatric communication skills to medical students.

BACKGROUND: Delivering effective clinical pediatric communication skills training to undergraduate medical students is a distinct and important challenge. Pediatric-specific communication skills teaching is complex and under-researched. We report on the development of a scenario-based pediatric clinical communication skills program as well as students' assessment of this module. METHODS: We designed a pediatric clinical communication skills program and delivered it five times during one academic year via small-group teaching. Students were asked to score the workshop in eight domains (learning objectives, complexity, interest, competencies, confidence, tutors, feedback, and discussion) using 5-point Likert scales, along with free text comments that were grouped and analyzed thematically, identifying both the strengths of the workshop and changes suggested to improve future delivery. RESULTS: Two hundred and twenty-one of 275 (80%) student feedback forms were returned. Ninety-six percent of students' comments were positive or very positive, highlighting themes such as the timing of teaching, relevance, group sizes, and the use of actors, tutors, and clinical scenarios. CONCLUSION: Scenario-based teaching of clinical communication skills is positively received by students. Studies need to demonstrate an impact on practice, performance, development, and sustainability of communications training.

Plasma oxytocin levels predict social cue recognition in individuals with schizophrenia.

Lower endogenous levels of the neuropeptide oxytocin may be an important biological predictor of social cognition impairments in schizophrenia (SZ). Prior studies have demonstrated that lower-level social cognitive processes (e.g., facial affect perception) are significantly associated with reduced plasma oxytocin levels in SZ; however, it is unclear whether higher-level social cognition, which requires inferential processes and knowledge not directly presented in the stimulus, is associated with endogenous oxytocin. The current study explored the association between endogenous oxytocin levels and lower- and higher-level social cognition in 40 individuals diagnosed with SZ and 22 demographically matched healthy controls (CN). All participants received the Social Cue Recognition Test (SCRT), which presents participants with videotaped interpersonal vignettes and subsequent true/false questions related to concrete or abstract aspects of social interactions in the vignettes. Results indicated that SZ had significantly higher plasma oxytocin concentrations than CN. SZ and CN did not differ on SCRT hits, but SZ had more false positives and lower sensitivity scores than CN. Higher plasma oxytocin levels were associated with better sensitivity scores for abstract items in CN and fewer false positives for concrete items in individuals with SZ. Findings indicate that endogenous oxytocin levels predict accurate encoding of lower-level socially relevant information in SZ.

Patient characteristics associated with buprenorphine/naloxone treatment outcome for prescription opioid dependence: Results from a multisite study.

BACKGROUND: Prescription opioid dependence is a growing problem, but little research exists on its treatment, including patient characteristics that predict treatment outcome. METHODS: A secondary analysis of data from a large multisite, randomized clinical trial, the National Drug Abuse Treatment Clinical Trials Network Prescription Opioid Addiction Treatment Study (POATS) was undertaken to examine baseline patient characteristics (N=360) associated with success during 12-week buprenorphine/naloxone treatment for prescription opioid dependence. Baseline predictor variables included self-reported demographic and opioid use history information, diagnoses assessed via the Composite International Diagnostic Interview, and historical opioid use and related information from the Pain And Opiate Analgesic Use History. RESULTS: In bivariate analyses, pre-treatment characteristics associated with successful opioid use outcome included older age, past-year or lifetime diagnosis of major depressive disorder, initially obtaining opioids with a medical prescription to relieve pain, having only used opioids by swallowing or sublingual administration, never having used heroin, using an opioid other than extended-release oxycodone most frequently, and no prior opioid dependence treatment. In multivariate analysis, age, lifetime major depressive disorder, having only used opioids by swallowing or sublingual administration, and receiving no prior opioid dependence treatment remained as significant predictors of successful outcome. CONCLUSIONS: This is the first study to examine characteristics associated with treatment outcome in patients dependent exclusively on prescription opioids. Characteristics associated with successful outcome after 12 weeks of buprenorphine/naloxone treatment include some that have previously been found to predict heroin-dependent patients' response to methadone treatment and some specific to prescription opioid-dependent patients receiving buprenorphine/naloxone.

Positive affect and stress reactivity in alcohol-dependent outpatients.

OBJECTIVE: Reactivity to stress is a common feature of alcohol dependence and is associated with poorer treatment outcome among alcohol-dependent patients. Despite the importance of stress reactivity in alcohol dependence, little is known about markers of resilience to stress in this population. The current study examined whether positive affect buffered the effect of stress on negative affect and alcohol craving in an alcohol-dependent sample. METHOD: Outpatients (N = 1,375) enrolled in a large, randomized controlled trial for alcohol dependence (the Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence [COMBINE] Study) completed measures of stress, positive affect, negative affect, and alcohol craving. In this secondary analysis, we hypothesized that positive affect would moderate the association between stress and negative affect and that positive affect would be negatively associated with craving. RESULTS: Results supported these hypotheses, such that patients with higher levels of positive affect exhibited a weaker relationship between stress and negative affect relative to those with low positive affect. Positive affect was negatively associated with craving but did not moderate the association between stress and craving. CONCLUSIONS: These results replicate studies suggesting a protective effect of positive affect on stress reactivity and extend this effect to an alcohol-dependent sample. If positive affect can aid in resilience to stress, the utilization of interventions that enhance positive affect may be of particular utility for alcohol-dependent patients. Future experimental studies testing the causality of this association as well as studies examining the effect of interventions to enhance positive affect are needed.

Structure-activity relationships for the 9-(pyridin-2'-yl)- aminoacridines.

A series of 9-(pyridin-2'-yl)-aminoacridines was prepared and analyzed for their ability to change the thermal denaturation temperature of genomic calf thymus DNA. Development of a QSAR equation indicated that electron withdrawing groups on the pyridine ring promoted the interaction with double stranded DNA.