Latent structure of psychotic experiences in the general population.

OBJECTIVE: There have been increasing pressures to adopt or incorporate dimensional representations in various sections of DSM-5 including the psychotic disorders section. Thus far, findings offered as evidence of a continuous distribution of psychosis are limited given their exclusive focus on the manifest rather than latent structure of psychotic experiences. The current study sought to determine whether or not psychotic experiences possess a taxonic or dimensional latent structure. METHOD: We investigated the latent structure of psychotic experiences in the Collaborative Psychiatric Epidemiological Surveys (CPES) and the National Comorbidity Survey (NCS). We analyzed responses of participants in these surveys with three multivariate taxometric procedures (MAMBAC, MAXEIG, and L-Mode) after summing responses on the surveys into three indicators of positive psychosis. RESULTS: Taxometric results tended to support a dimensional, rather than taxonic structure for psychotic experiences. In the CPES, all taxometric methods produced graphical and numerical support for a dimensional structure. In the NCS, MAMBAC appeared to slightly support a taxonic structure, whereas MAXEIG and L-Mode supported a dimensional structure. CONCLUSION: There appears to be a dimensional distribution of psychotic experiences in the general population. This supports the incorporation of dimensional representations of psychotic symptoms in the current diagnostic system.

Parent management training.

As the estimates of prevalence and cost of mental health problems in our children continue to rise, it is incumbent on our society to have an effective and cost-efficient means to address this health crisis. Consistently, the research literature indicates that PMT offers great promise as an efficacious treatment of conduct-disordered children. There are recent studies of PMT's benefits as a preventive intervention that not only improves children's conduct but also positively affects parent-child relationships, mood, social competence, and school adjustment or performance. Although relatively untested, there are indications that PMT also could play an important adjunctive role in the treatment of internalizing disorders. As a curriculum-driven and didactic form of treatment, PMT is highly adaptable to various treatment and prevention contexts, and from a managed care perspective, PMT's structure allows its costs to be well defined and managed. Despite these positive attributes, however, few clinics systematically offer PMT as a treatment option, and third-party payers have been reluctant to cover its costs. Although it is conceded that much needs to be learned about the scope of PMT's effectiveness and the modifications that are necessary to improve its adaptability to high-risk families, it is proposed that PMT should join the mainstream of broadly available health care provisions for children and their families. This broad inclusion of PMT requires mental health educators to include PMT training as a standard part of provider training, requires that third-party payers include PMT as a covered service, and requires that local and federal governments support the proliferation of PMT in treatment and prevention initiatives.

Perceived smokeless tobacco addiction among adolescents.

Although the prevalence and associated factors of smokeless tobacco (SLT) use are well-documented, there are no data on the prevalence and associated factors of SLT dependence-addiction. From a survey of 11,057 adolescents in the nonurban Southeastern United States, 3,726 reported having tried SLT, and 17% of those who had tried SLT perceived that they were addicted to it. Years of SLT use, frequency of use per day, and hours of exposure per day were strongly related to perceived addiction. Those using SLT for 1 year or longer had perceived addiction rates of 37% and were over 12 times more likely to report being addicted than were those using for less than 1 year. After controlling for level of SLT use, other factors including parental SLT use, perceived control over health, and racial-ethnic group also contributed minimally but significantly to reported SLT addiction.

The medical context of hypochondriacal traits.

OBJECTIVE: This study examines the effects of two medical contexts on the relationship of hypochondriacal traits and their potential correlates. METHOD: Correlates of hypochondriacal traits were compared from a matched sample of fifty-five general medical inpatients with a sample of fifty-five medical inpatients referred for psychiatric evaluation. Patients completed questionnaires assessing emotional distress and health attitudes, beliefs, and behaviors, and their attending physician completed ratings of the patient's illness and illness behavior. RESULTS: Patients referred for psychiatric consultation exhibited significantly higher levels of hypochondriacal illness presentation than the matched nonreferred sample. Moderated regression analyses revealed three trends regarding the interactive effects of group status on the relationship of hypochondriacal traits to their potential correlates: 1) presence of angry feelings and interpersonal friction was positively associated with hypochondriacal concerns for the psychiatric referred patients only, 2) the tendency to deny life stresses and attribute all problems to the effects of illness was positively associated with a misinterpretation of the severity of their illness and hypochondriacal illness presentation for the psychiatric referred patients, whereas this association was negative for the nonreferred medical patients, and 3) the association of reports of emotional distress symptoms with hypochondriacal illness preparation was negative for the psychiatric referred patients and positive for the nonreferred medical patients. CONCLUSIONS: Study results suggest that hypochondriasis may not represent a uniform nosological disorder and that the context of its study can significantly influence etiologic findings.

Difficult parents. From adversaries to partners.

The pediatrician's job becomes frustrating when it is necessary to deal with difficult parents. Some physicians may not have the training or inclination to engage such parents in a therapeutic partnership. This paper discusses tools available to physicians which will help them develop an effective partnership that includes uncovering the hidden meaning behind a child's illness; understanding the reciprocal nature of partnerships; and the importance of determining each party's goals, roles, and expectations. Negotiating these steps enables physicians to develop a productive relationship with difficult parents of sick children. This strategy can facilitate the child's medical care and improve the parents' and physician's satisfaction with the services rendered. This paper also discusses steps to take when these attempts are not sufficient to handle the situation.

The relationship of anger and child psychopathology.

This study examines the relationship of anger to child psychopathology in an inpatient psychiatric sample. Results suggest that anger as assessed by the Children's Inventory of Anger is not highly correlated with other affective experiences or behavioral dispositions, yet may provide incremental data pertinent to distinguishing children with concurrent disturbances of emotion and conduct from children with disturbances in either emotion or conduct.

The effects of psychiatric hospitalization on behaviorally disordered children: a preliminary evaluation.

The importance of outcome research in the field of children's mental health treatment has increased in recent years because of enhanced consumer awareness, a decrease in available resources, and payers' demand for accountability. The present study evaluated the treatment program of a child psychiatric unit in a public university hospital in the southeastern United States. The research used a single-group, pre- and post-test design and the Child Behavior Checklist (CBCL) as the outcome measure. Children receiving inpatient psychiatric treatment demonstrated statistically significant improvements in CBCL scores. The strengths and limitations of this study are discussed.

Derivation and implications of MMPI cluster groups in clinically depressed inpatient females.

The purpose of this study was to subclassify clinically depressed patients based on a cluster-analytic examination of the MMPI. Subjects were 79 female inpatients with major depression. A cluster analysis of the MMPI validity and clinical scales resulted in three clusters labeled psychotic (287 MMPI profile), hostile (24 MMPI profile), and histrionic (32 MMPI profile) depression. The psychotic group exhibited the greatest depression as measured by the Beck Depression Inventory (BDI). The psychotic and hostile groups, however, did not differ on other associated aspects of depression, such as negative cognitions, nonassertiveness, or personality style. The hostile group reported the fewest physical difficulties and the most excessive alcohol use. The groups, however, did not differ on other aspects of depression history or presentation such as family history of depression or previous hospitalizations. A repeated measures ANOVA for the three cluster groups on the BDI at admission, discharge, and 6 months after discharge indicated that all groups showed improvement at discharge but that only the hostile depressive group continued to show improvement at the 6-month follow-up.

Questionnaires in behavioral pediatrics: guidelines for selection and use.

There is a death of information for pediatricians to use in choosing questionnaires that would be useful in medical practice. In this article, general guidelines are presented for primary child health clinicians to use in selecting questionnaires. Concepts such as reliability, validity, readability, response format, scoring and completion time, and norms are reviewed, and the implications of these concepts for practitioners are discussed. Guidelines are applied to selected behavioral questionnaires to illustrate their importance.

The role of race and ethnic status on the psychosocial correlates of smokeless tobacco use in adolescent males.

From a stratified, random sampling of non-urban high schools in the Southeast, survey data were obtained from 5374 adolescent males. Over half reported trying smokeless tobacco, and approximately one third of these reported a regular, substantial level of use. The average age at initial use was 12.2 yr. and was negatively correlated with the level of use. Factor analysis of the psychosocial items resulted in four factors: substance use/deviant style, modeling, perceived negative consequences, and health behavior. Discriminant analysis of initial use indicated that substance use and modeling influences were the strongest predictors of trying smokeless tobacco. Regression analysis of level of smokeless tobacco use indicated that substance use, modeling, and perceived negative consequences were equivalent in their contribution. Separate analyses were performed for American Indian, Black, and White males. Although predictors of initial use were similar, level of smokeless tobacco use was most associated with the use of other substances in Blacks and with modeling influences in Whites.

Examining emotional distress during pediatric hospitalization for school-aged children.

Emotional distress was examined in 80 school-aged children during pediatric hospitalization. Using multiple regression analyses, children's depressive and anxious symptoms were positively related to duration of physical symptoms and parental distress. Depressive symptoms were negatively related to age and the perceived social support available from the family. Unexpectedly, the frequency of medical procedures and previous hospitalization experiences were not associated with depressive or anxious symptoms. Because many of the children in this study had experienced enduring symptoms and frequent previous hospitalizations, it was hypothesized that they may have habituated and adjusted to many of the experiences of hospitalization and thus were not adversely affected by such experiences.

Smokeless tobacco use in adolescent females: prevalence and psychosocial factors among racial/ethnic groups.

From a stratified, random sampling of Southeastern, nonurban high schools, survey data on smokeless tobacco use and potential psychosocial risk factors were obtained from 5683 adolescent females. Of the 15.3% who reported trying smokeless tobacco, most (75%) reported only experimental use. Factor analysis of the psychosocial items resulted in four factors: perceived negative consequences, substance use, modeling, and active lifestyle. Discriminant analysis on use indicated that modeling influences and use of other substances were the strongest predictors of initial smokeless tobacco use. Level of use, however, was most strongly associated with lower perceived negative consequences for use and the use of other substances. Separate analyses on American Indian, Black, and White subgroups suggested that factors associated with initial use were similar but that substantial differences exist between subgroups on risk factors for level of smokeless tobacco use.

Managing somatization phenomena in primary care.

Patients communicating psychological distress in the form of somatic symptoms and seeking medical care for them pose difficult diagnostic and treatment dilemmas for the primary care physician. Somatization may be conceptualized as an illness-focused behavior style, with multiple etiologies, rather than a single psychiatric disorder. Somatizing behavior is associated with emotional distress, cognitive-perceptual abnormalities, and socially learned illness behaviors. Although recognition of the somatizing patient begins with thorough medical evaluation, assessment should also include careful examination of social history and the affective meaning of symptoms. Management strategies will vary according to the etiology of the psychiatric diagnosis associated with physical symptoms; however, the essential element is provision of a long-term supportive relationship with a physician, who provides effective monitoring of physical and mental health status, appropriate emotional support, and reassurance concerning symptoms.

A comparison of two stress-reduction treatments for mothers of neonates hospitalized in a neonatal intensive care unit.

Thirty mothers of preterm infants requiring neonatal intensive care unit (NICU) hospitalization were assigned randomly to one of three groups to assess differences in treatment effectiveness of facilitating parental adaptation to the NICU stresses. Groups consisted of: (a) a treatment group receiving videotape training in active problem-focused coping strategies; (b) a treatment group receiving videotape training in emotion-focused strategies to help manage anxiety; and (c) a control group receiving promotional information about the hospital and the NICU. On pretreatment measures most of the mothers exhibited little distress, a finding unlike those for the majority of NICU studies. On posttreatment follow-up both the problem-focused and emotion-focused treatment groups were significantly less anxious than the controls and lower levels of depression were observed for the emotion-focused group. Findings suggest that the coping interventions examined were cost efficient and appear promising in facilitating mothers' coping with NICU stresses.

Social desirability response tendencies in psychiatric inpatient children.

This study examined the substantive features of children's social desirability (SD) tendencies that could influence the nature and severity of psychopathology. Examinations of substantive features of SD responding in an inpatient child psychiatry unit (N = 76) suggested that higher scores on the Children's Social Desirability questionnaire were associated strongly with (1) lower mental age; (2) higher scores on self-reported social competence; (3) lower scores on self-reported anger; and (4) lower scores on parent-reported externalization behavioral disturbance. Results were interpreted as suggesting that SD responding for child inpatients may reflect a mixed picture of negative features of cognitive and social immaturity that could affect adversely their ability to judge their own and others' social behavior and of positive features of less external behavioral disturbance and more prosocial attitudes and behaviors.

Assessment of children's Type A behavior: relationship with negative behavioral characteristics and children and teacher demographic characteristics.

Thirty-two teachers rated Type A behavior, using Matthews Youth Test for Health, (MYTH) and negative characteristics of hyperactivity, negative peer relations, social withdrawal, and depression in 105 children, between the ages of 6 and 11, from lower to middle class Black and White families. Children's age, gender, race, and socioeconomic status (SES) and teachers' gender, grade taught, and years of teaching experience were not related to teachers' MYTH ratings. However, White teachers rated children higher on Type A behavior than Black teachers. Controlling for teacher race effects, MYTH total scores, rather than reflecting a global negative view of the child, showed a strong overlap with hyperactivity and were differentiated from social withdrawal and depression. The MYTH Impatience/Aggression factor was highly related to hyperactivity and negative peer interactions; the Competitiveness factor was associated with a lack of social withdrawal. The conclusions verify the multidimensional nature of children's Type A behavior pattern and the importance of rater demographic characteristics in the assessment of children's behavior.

The relationship between hostility and blood pressure in children.

The relationship between two dimensions of hostility and resting blood pressure was examined in 98 children aged 7 to 10 years. The children completed the expressive and experienced hostility subscales of the Buss-Durkee Hostility Inventory and one week later had blood pressure and obesity levels assessed. Multiple regression analyses and analyses of variance showed that expressive hostility was positively associated with blood pressure, although this relationship became marginally significant when the effects of obesity were controlled. A significant inverse relationship was found between experienced hostility and systolic blood pressure. These results are discussed as they relate to findings in adults on hostility and cardiovascular disease and the relationship between hostility, blood pressure, and obesity.

Illness coping strategies and hypochondriacal traits among medical inpatients.

The Illness Coping Strategies scale (ICS) is an 18-Likert-item scale developed to examine illness appraisal and coping by medical patients more comprehensively than instruments which screen for hypochondriacal traits in this population. This study has examined the association of hypochondriacal traits with illness coping strategies addressed by the ICS among 101 randomly selected inpatients drawn from a general medicine unit of a teaching general hospital. Despite the exclusion of patients with substance abuse or organic mental disorder, or referral for psychiatric consultations, hypochondriacal traits were prevalent in this inpatient sample. Five factor-derived subscales of the ICS (disease vigilance, limit activity, overresponsiveness, self-treatment and obsessive worry) were extracted, and internal consistency and test-retest reliabilities were determined. Multiple regression analysis on a composite measure of hypochondriasis revealed that the five ICS factor scales accounted for 26 percent of the variance. Patients with a high hypochondriacal index had associated high scores on symptom vigilance, limit activity and obsessive worry subscales, suggesting that these illness coping strategies may represent an important aspect of hypochondriacal illness presentation. The self-treatment subscale appeared to act as a suppressor variable, contributing to the prediction of the hypochondriacal index by extracting self treatment aspects from the other illness coping factors. Illness coping responses found to be associated with hypochondriacal traits in this study were rather passive strategies which promoted increased vigilance and concern about symptoms while providing few opportunities to reduce uncertainty regarding health status.

Physician interpretation of illness behavior.

Determining factors in physician recognition of emotional factors in the illness presentation of their patients was examined by stepwise multiple regression analysis, utilizing 18 predictor variables, in a sample of 101 randomly selected internal medicine inpatients. Self-report measures of patients' psychological symptoms failed to explain a significant percentage of the variance in physician assessment of emotional factors in illness. Physician assessment of severity of medical illness, patient satisfaction with present medical care, and age predicted 58 percent of the variance in physician ratings of emotional factors in illness. Physicians attributed greater emotional morbidity to patients judged to have less severe medical illness and to be less satisfied with their care. Using only patient variables as independent predictors, number/frequency of symptoms and race accounted for 16 percent of the variance in physicians' ratings. These results suggest that physician expectations about normative illness behavior, more than mental status characteristics documented by patient self-report measures, determine the recognition of significant emotional factors in illness presentation.

Survey of admission policies for child and adolescent inpatient services: a national sample.

In a national sampling of child inpatient directors, survey responses suggested variability in the use of many admission criteria. Yet, severity of symptoms, potential effectiveness of outpatient treatment, and extent of medical complications appeared to be commonly used admission criteria. DSM-III diagnoses were inconsistently used admission criteria, and many diagnoses were considered suitable for admission in extenuating circumstances only.