Effect of Mirtazapine on Nausea in Children with Functional Nausea and Functional Dyspepsia Postprandial Distress Syndrome.

OBJECTIVE: The objective of this study was to assess the clinical response and safety of mirtazapine in the pediatric population with a diagnosis of functional nausea and nausea associated with functional dyspepsia postprandial distress syndrome. METHODS: This was a retrospective chart review to evaluate the safety and efficacy of mirtazapine for pediatric nausea and nausea associated with functional dyspepsia postprandial distress syndrome. Clinical response was classified as complete response, partial response, and no response. We also identified the prescribed doses, side effects, and weight changes during mirtazapine therapy. RESULTS: Among the 57 total patients, 67% were females and ages ranged from 7 to 19 years with a mean of 14 ± 3 years. Clinical (complete and partial) response was reported in 82% of patients. Nausea resolved in 82% and insomnia in 77% of the patients. Eighty-four percent gained weight with a mean of 4 ± 7 kg. Sixty-five percent did not report adverse effects. The most common adverse effects were undesired weight gain (16%) and dysphoria (9%). Two patients discontinued the medicine after the first dose because of adverse effects. There was a significant correlation between the initial dose and weight (rs = 0.478; p = 0.0002). The median initial and final doses were 15 mg, respectively. CONCLUSIONS: Mirtazapine is an option for treating children and adolescents with functional nausea and nausea associated with functional dyspepsia post-prandial distress syndrome, especially for a select group of patients with concurrent weight loss, anxiety, and insomnia.

Motivational Interviewing for Victims of Armed Community Violence: A Nonexperimental Pilot Feasibility Study.

OBJECTIVE: The present study aimed to develop a novel, hospital-based motivational interviewing (MI) intervention for victims of armed community violence (MI-VoV) targeting patient-specific risk factors for future violence or violent victimization. METHOD: This uncontrolled pilot feasibility study examined a sample of patients (n = 71) hospitalized due to violent injury at a Level 1 Trauma Center in [Location Redacted for Masked Review] between January 2013 and May 2014. Patients first participated in a brief assessment to identify risk factors for violence/violent injury. A single MI session then targeted risk behaviors identified for each patient. Proximal outcomes, including motivation for change and behaviors to reduce risk, were examined at 2 weeks and 6-12 weeks post-discharge. Distal outcomes, including fighting, weapon-carrying, and gun-carrying, and other violence risk factors were examined at 6-12 week follow-up. RESULTS: Ninety-five patients were offered participation, 79 (83.2%) agreed to participate, and 73 (76.8%) completed the risk assessment. Of these, 71 had at least one violence/violent injury risk factor. Behaviors to reduce risk were significantly greater at two-week and 6-12 week follow-up (ps < .05). Fighting, weapon-carrying, gun-carrying were significantly reduced at 6-12 week follow-up (p < .05). CONCLUSIONS: This intervention appears to be feasible to implement and acceptable to patients. A randomized controlled trial evaluating efficacy appears warranted.

The role of intolerance of uncertainty in social anxiety subtypes.

OBJECTIVES: Intolerance of uncertainty (IU) is thought to underlie several internalizing disorders; however, it has only begun to be explored within social anxiety (SA). This study extends previous findings by examining IU's relation to performance and interaction SA subtypes and by accounting for obsessive-compulsive symptoms. METHODS: A total of 472 undergraduates completed measures of IU, SA, perfectionism, worry, obsessions/compulsions, and fear of negative evaluation (FNE). RESULTS: IU and obsessions/compulsions predicted performance SA beyond FNE. IU predicted interaction SA beyond FNE. Inhibitory anxiety IU contributed to both SA types but contributed more to performance SA. Prospective anxiety IU was negatively related to performance SA and unrelated to interaction SA, though a trend emerged. Contrasts between those high in one SA type, both, or neither revealed IU was highest when both types were present. CONCLUSIONS: Inhibitory IU plays a significant role in both SA subtypes and may play a slightly greater role in performance SA.

Somatic symptoms in those with performance and interaction anxiety.

This study (n = 304) examined the relationship between somatic symptoms and social anxiety. Significant differences in the experience of somatic symptoms were found among four groups (i.e. performance anxious, interaction anxious, generalized socially anxious, and controls). Post hoc analyses revealed that those who exceeded the clinical cutoff for generalized social anxiety exhibited more somatic symptoms than those who exceeded the clinical cutoff in the other two social anxiety domains or controls. Individuals in each group exhibited more somatic symptoms than controls, but subtypes did not differ in the amount of somatic symptoms experienced. Additionally, regression analyses revealed that type of somatic symptoms experienced varied depending on subtype.

Age differences in high frequency phasic heart rate variability and performance response to increased executive function load in three executive function tasks.

The current study examines similarity or disparity of a frontally mediated physiological response of mental effort among multiple executive functioning tasks between children and adults. Task performance and phasic heart rate variability (HRV) were recorded in children (6 to 10 years old) and adults in an examination of age differences in executive functioning skills during periods of increased demand. Executive load levels were varied by increasing the difficulty levels of three executive functioning tasks: inhibition (IN), working memory (WM), and planning/problem solving (PL). Behavioral performance decreased in all tasks with increased executive demand in both children and adults. Adults' phasic high frequency HRV was suppressed during the management of increased IN and WM load. Children's phasic HRV was suppressed during the management of moderate WM load. HRV was not suppressed during either children's or adults' increasing load during the PL task. High frequency phasic HRV may be most sensitive to executive function tasks that have a time-response pressure, and simply requiring performance on a self-paced task requiring frontal lobe activation may not be enough to generate HRV responsitivity to increasing demand.

Differentiating among singular and comorbid obsessive-compulsive disorder and social phobia symptomology.

Social phobia is a frequent co-occurring diagnosis with obsessive-compulsive disorder (OCD); however, co-occurring OCD in those with social phobia is less common. Genetic, environmental, and cognitive traits are common risk factors for anxiety disorders broadly. It is plausible that shared variables related to OCD and/or social phobia could provide insight into the co-occurrence of these two disorders. The current study explored differences in fear of negative evaluation (FNE) and perfectionism among four groups: those with (1) elevated social phobia symptoms, (2) elevated OCD symptoms, (3) elevated symptoms of OCD and social phobia, and those who were (4) asymptomatic as a control group. A non-clinical sample of 196 participants completed several online questionnaires about social phobia and OCD symptomology. Results identified three cognitive variables (i.e., FNE, total perfectionism, and concern over mistakes) as differential variables in comorbid symptom presentation of OCD and social phobia. A fourth variable (i.e., doubts about actions) was identified as a potential dual risk factor, and four subsequent variables (i.e., parental criticism, personal standards, parental expectations, and organization) were not implicated in differential symptom presentation. Given the different rates of OCD and social phobia co-occurrence, identification of differentiating variables could aid in better understanding of potential risk factors, which may enhance preventative and therapeutic techniques. Study implications, limitations, and future recommendations are discussed.

The behavioral avoidance task using imaginal exposure (BATIE): a paper-and-pencil version of traditional in vivo behavioral avoidance tasks.

Behavioral avoidance tasks (BATs) have been used for decades in the assessment of specific phobias, but they also involve a number of prohibitive difficulties. This study investigated a new imaginal/self-report instrument, the Behavioral Avoidance Task Using Imaginal Exposure (BATIE), and evaluated whether it was an efficient paper-and-pencil alternative. Forty-nine adults diagnosed with specific phobias were matched to 49 participants without those particular phobias who served as control participants. The participants were 89.8% female and 79.6% Caucasian and had a mean age of 20.81 years (SD = 3.62). Diagnosis was determined using the Anxiety Disorders Interview Schedule (Brown, DiNardo, & Barlow, 1994). Participants completed a BAT following a BATIE. Results indicated BATIE ratings significantly correlated with BAT performance and ratings. Significant differences were also found between the phobic and control groups on all BATIE ratings (all differences indicated poorer performance or more fear in those with specific phobias). Also, the BATIE scores demonstrated good evidence of convergent and discriminant validity compared to other self-reports, significantly predicted BAT performance even when controlling for those measures of fear and anxiety, and significantly predicted diagnostic severity ratings. Overall, results indicated that the BATIE may be a reasonable alternative to in vivo BATs in certain situations (e.g., clinical practice, unavailability of BAT stimuli).

Intolerance of uncertainty as a mediator of the relationship between perfectionism and obsessive-compulsive symptom severity.

BACKGROUND: Intolerance of uncertainty (IU) and perfectionism have both been shown to predict severity of obsessive-compulsive disorder (OCD) symptoms in populations diagnosed with OCD, as well as analogue samples. According to cognitive models of OCD, symptoms are maintained by dysfunctional beliefs including IU and perfectionism. The purpose of the current study is to extend research on the cognitive theory of OCD by describing how dysfunctional thoughts interact with each other. METHODS: In an analogue sample for OCD (N = 475), undergraduate students completed measures online pertaining to IU (IU scale), perfectionism (Frost Multidimensional Perfectionism Scale), and OCD symptoms and severity (Florida Obsessive-Compulsive Inventory). RESULTS: The proposed model of IU fully mediating the relationship between perfectionism and OCD severity was supported using structural equation modeling (SEM) analysis. Bootstrapping testing within AMOS 20 and Sobel tests further corroborated full mediation. CONCLUSIONS: Results from the current study suggest that IU fully mediates the relationship between perfectionism and severity of OCD symptoms. This finding has an impact for understanding the nature and treatment of OCD with perfectionism as a primary symptom. Findings suggest that in order to address perfectionism, it is necessary to first treat cognitions and obsessions associated with IU and that this practice would lessen distress and interference associated with perfectionistic obsessions.

The comorbidity of psychotic symptoms and posttraumatic stress disorder: evidence for a specifier in DSM-5.

The comorbidity of posttraumatic stress disorder (PTSD) and psychotic symptoms is higher than what might be expected based on the prevalence of either disorder alone. Furthermore, the presence of psychotic symptoms is evident in PTSD patients who do not otherwise meet criteria for a psychotic spectrum disorder. The current paper discusses three existing hypotheses regarding the relation of PTSD and psychosis and presents a series of case studies that illustrates this phenomenon across a diverse group of patients and scenarios. Clinical implications in light of these case studies are offered, including the suggestion that the next edition of the Diagnostic and Statistical Manual of Mental Disorders includes a specifier of PTSD with psychotic features.

Treating selective mutism using modular CBT for child anxiety: a case study.

Selective mutism is a rare, debilitating condition usually seen in children. Unfortunately, there is little research examining effective treatments for this disorder, and designing an evidence-based treatment plan can be difficult. This case study presents the evidence-based treatment of an 8-year-old Caucasian boy with selective mutism using an established treatment for anxiety--Modular Cognitive-Behavioral Therapy for Childhood Anxiety Disorders (Chorpita, 2007). The treatment consisted of 21 sessions and included modules on psychoeducation, exposure, cognitive restructuring, social skills, and maintenance and relapse prevention. The client's symptoms were greatly improved by the end of treatment based on fear hierarchy ratings, self-report and parent-report questionnaires, and child and parent clinical interviews. In addition, at discharge the client no longer met criteria for selective mutism. Improvements were maintained when the client was reassessed at 1-month and 6-month follow-up appointments.

Fear of anxiety as a partial mediator of the relation between trauma severity and PTSD symptoms.

Fear of anxiety has previously been found to be a predictor of overall symptoms of posttraumatic stress disorder (PTSD). The current exploratory study examines the relationship between fear of anxiety and symptoms of PTSD in a sample of adults exposed to Hurricane Katrina. Fear of anxiety was found to partially mediate the relationship between the severity of trauma and the severity of PTSD. Further, this mediation was found to operate differently by gender, with the mediation holding true for men but not for women. For both men and women, fear of anxiety was positively correlated with PTSD symptoms.