Interview schedule for children and adolescents (ISCA).

OBJECTIVE: To describe the development, use, and psychometric properties of the semistructured, symptom-oriented Interview Schedule for Children and Adolescents (ISCA) and its versions suitable for reevaluation. METHOD: Data are summarized on the reliability, construct validity, and predictive validity of symptom ratings and resultant diagnoses, and information regarding the feasibility of a version of the ISCA for young adult subjects is presented. RESULTS: The evidence suggests that these instruments yield reliable symptom ratings and diagnoses relevant to a wide range of syndromes and diagnoses over time and that the ISCA is useful with psychiatric and pediatric medical populations. CONCLUSIONS: The ISCA and its follow-up versions are useful clinical tools in research focusing on developmental psychopathology.

Stressful life events, bipolar disorder, and the "kindling model".

A common misconception is that bipolar disorder is an endogenous process. However, previous research suggests a role for life events in the onset of and recovery from bipolar episodes. Yet, there remains some question as to whether the relationship between life events and onset changes over the course of the disorder as a result of the number of episodes an individual has experienced. Using a rigorous interview measure of stressful life events, the current study tested the kindling model (R. M. Post, 1992), which theorizes that major life events play a diminishing role over the course of illness in bipolar patients. Analyses revealed that the number of episodes experienced does not appear to have a significant effect on bipolar 1 patients' reactivity to external stressors. In addition, the results suggest that a more complex relationship exists among age, stress, and onset of new episodes than can be adequately explained by the kindling model.

Social rhythm disruption and stressful life events in the onset of bipolar and unipolar episodes.

BACKGROUND: An association between social rhythm disruption (SRD) and onset of manic episodes has recently been observed. Whether other types of bipolar (depressive and cycling) or unipolar depressive episodes are similarly related to SRD is unclear, as is the association between severely threatening life events and onset of bipolar manic, depressed and cycling episodes. METHODS: Bipolar patients with purely manic (N= 21), purely depressed (N = 21) and cycling (N = 24) episodes, and 44 patients with recurrent unipolar depression, were interviewed with the Bedford College Life Events and Difficulties Schedule. The presence of severe and SRD events during the year prior to index episode onset was then determined. RESULTS: More manic than cycling and unipolar subjects experienced SRD events during 8- and 20-week pre-onset periods, and severe events during 20-week pre-onset periods. Controlling for age and prior number of episodes left most findings unchanged. An earlier finding of more manic subjects with SRD events in an 8-week pre-onset versus control period was also replicated. CONCLUSIONS: It appears that manic onsets are influenced by stressful life events, especially those involving SRD, in a unique manner compared to onsets of other types of bipolar and unipolar episodes. Onset of bipolar cycling episodes, in contrast, seems to be relatively unaffected by SRD or severe life events. These findings refine the hypothesis that SRD may precipitate onset of affective episodes to be specific to manic onsets.

Stressful life events and social rhythm disruption in the onset of manic and depressive bipolar episodes: a preliminary investigation.

BACKGROUND: The association between stressful life events and onset of bipolar episodes is unclear. The association between bipolar episode onset and types of life events that disrupt social routines, and potentially sleep, has not yet been investigated. METHODS: Thirty-nine bipolar patients with primarily manic (n = 20) or depressed (n = 19) index episodes were interviewed with the Bedford College Life Event and Difficulty Schedule to determine the presence of severe events during 8-week pre-onset and control periods. All life events were also rated for degree of social rhythm disruption (SRD). RESULTS: More bipolar subjects experienced at least 1 SRD event and severe event in the pre-onset vs control periods. When subjects were divided into those with manic or depressive onsets, the only significant pre-onset vs control difference was for manic patients with SRD events. Additionally, the proportion of subjects with a pre-onset SRD event was greater for manic than for depressed patients. CONCLUSIONS: We found evidence that life events characterized by SRDs routines are associated with the onset of manic, but not depressive, episodes. Severe events seem to be related to onset of bipolar episodes, although it remains unclear whether severe events relate differentially to depressive and manic onsets.

Psychoeducational workshops for elderly patients with recurrent major depression and their families.

OBJECTIVE: This report details an extension of the use of psychoeducational workshops with psychiatric patients and their families to families of elderly patients with recurrent unipolar late-life depression. METHODS: Subjects were 132 participants in a study of maintenance therapies for late-life depression and their 182 family members and significant others who accepted invitations to single-session family workshops. Participants provided feedback on their satisfaction with the content and quality of the workshops. Associations between workshop attendance, preworkshop demographic and clinical characteristics, treatment adherence, and outcome were explored through comparisons between 108 patients who attended workshops and 24 patients who declined the workshop invitation. RESULTS: Favorable feedback from participants suggested that the extension of the workshops to families of elderly patients with depression was successful. Workshop attendance was associated with a lower rate of dropout during continuation treatment. CONCLUSIONS: Results associating workshop refusal and treatment dropout, as well as the overall treatment compliance and retention rates in this randomized clinical trial involving geriatric patients, support the need for further study of factors relating to elderly patients' willingness to engage in family-centered interventions.

Is life stress more likely to provoke depressive episodes in women than in men?

One of the most consistent findings in psychiatric research is that rates of major depression are at least twofold higher among women than among men. Although there is considerable agreement in the literature that life events play a role in producing, triggering, or maintaining episodes of depression, less is known about the relationship among gender, life events, and depression. In the present study, we compared the rates, focus ("interpersonal" vs. "non-interpersonal"), and timing of stressful life experiences reported in rigorous interviews of male and female patients with unipolar recurrent depression and nondepressed contrast subjects. Consistent with hypotheses, female patients were more likely to experience stressful life experiences than their male counterparts; rates of stressful life experiences did not differ between female and male controls. Unexpectedly, rates of interpersonal stress did not differ among males and females regardless of patient or control status. We also found no significant differences in the timing of pre-onset events: stressful events were generally concentrated in the period immediately preceding onset for both men and women. Thus, although these data suggest that life stress may play a larger role in the provocation of recurrent episodes of depression for women than for men, there do not seem to be sex differences in the extent to which interpersonal vs. noninterpersonal events and difficulties are associated with depression onset or in the temporal distribution of events. Implications of these results are discussed in the context of research on other putative factors contributing to gender differences in rates of depression.

When reprimand consistency may and may not matter.

The present study examined the importance of discipline consistency by varying not only the probability of punishment but also the nature of the discipline agent's response to nonpunished transgressions. Eighteen first through third graders attending a remedial summer school were assigned to one of four feedback conditions in a 2 (Low vs. High Reprimand Consistency) x 2 (Ignore vs. Attend) design. An analysis of the simple effects of reprimand consistency indicated that consistency was important only when the teacher's alternative response was attending. Thus the nature of the adult's response to nonpunished transgressions is important for understanding how discipline consistency affects children's behavior. The importance of conceptualizing discipline consistency as a multivariate construct and of understanding the variables and parameters that may interact with the probability of punishment are discussed.