No relations between executive functions and dimensional models of psychopathology or is time the missing link?

Impaired executive functions (EF) have been found within various mental disorders (e.g., attention deficit hyperactivity disorder, autism spectrum disorder, schizophrenia spectrum disorders) as described in DSM-5. However, although impaired EF has been observed within several categories of mental disorders, empirical research on direct relations between EF and broader dimension of psychopathology is still scarce. Therefore, in the current investigation we examined relations between three EF performance tasks and self-reported dimensions of psychopathology (i.e., the internalizing, externalizing, and thought disorder spectra) in a combined dataset of patients with a broad range of mental disorders (N = 440). Despite previously reported results that indicate impaired EF in several categories of mental disorders, in this study no direct relations were found between EF performance tasks and self-reported broader dimensions of psychopathology. These results indicate that relations between EF and psychopathology could be more complex and non-linear in nature. We evaluate the need for integration of EF and dimensional models of psychopathology and reflect on EF as a possible transdiagnostic factor of psychopathology.

On the relationship between emotion regulation difficulties and posttraumatic stress symptoms during treatment: A test of reciprocity.

Positive associations between difficulties in emotion regulation and PTSD symptom severity have been consistently found in the literature. Little is known whether these associations are the result of reciprocal effects between the two constructs. This study investigated the reciprocal relationship between post-traumatic stress symptoms and emotion regulation difficulties. The study used a longitudinal design with two time points. The sample consisted of 293 patients who were all in treatment for PTSD. We estimated the cross-lagged panel model with latent variables. The results showed a significant cross-lagged effect of emotion regulation difficulties on post-traumatic stress symptoms. This finding highlights that emotion regulation difficulties play a pivotal role in the development and maintenance of post-traumatic stress. Therefore, exploring emotion regulation difficulties early on in treatment may support the effectiveness of trauma-focused interventions.

Youth Perceived Social Support and Symptom Distress: A Random-Intercept Cross-Lagged Panel Model.

Although social support and mental health associations have been extensively investigated, their reciprocal relations in vulnerable youth remain understudied. This study investigated the relations between perceived social support and symptom distress over time whilst differentiating between support from caregivers and significant others. The sample included 257 youth (79% self-identified women, Mage = 19.2, SD = 2.5) who were receiving mental health treatment. Using a Random-Intercept Cross-Lagged Panel Model, results revealed no significant concurrent associations, between-person effects, or cross-lagged effects. The autoregressive effects suggested that perceived social support from caregivers was relatively stable over time, while symptom distress and support from a significant other were not. In all, this study challenged the validity of the social causation and social erosion models in the context of perceived social support and symptom distress among vulnerable youth, revealing an absence of significant reciprocal associations. The stable nature of perceived social support from caregivers compared to support from significant others was highlighted. The study design, hypotheses, and target analyses were preregistered under https://osf.io/f4qpg .

Exploring the behavioral and cognitive phenotype of KBG syndrome.

KBG syndrome is a neurodevelopmental disorder, caused by dominant mutations in ANKRD11, that is characterized by developmental delay/intellectual disability, mild craniofacial dysmorphisms, and short stature. Behavior and cognition have hardly been studied, but anecdotal evidence suggests higher frequencies of ADHD-symptoms and social-emotional impairments. In this study, the behavioral and cognitive profile of KBG syndrome will be investigated in order to examine if and how cognitive deficits contribute to behavioral difficulties. A total of 18 patients with KBG syndrome and a control group consisting of 17 patients with other genetic disorders with comparable intelligence levels, completed neuropsychological assessment. Age-appropriate tasks were selected, covering overall intelligence, attention, memory, executive functioning, social cognition and visuoconstruction. Results were compared using Cohen's d effect sizes. As to behavior, fewer difficulties in social functioning and slightly more attentional problems, hyperactivity, oppositional defiant behavior and conduct problems were found in the KBG syndrome group. Regarding cognitive functioning, inspection of the observed differences shows that patients with KBG syndrome showed lower scores on sustained attention, cognitive flexibility, and visuoconstruction. In contrast, the KBG syndrome group demonstrated higher scores on visual memory, social cognition and emotion recognition. The cognitive profile of KBG syndrome in this sample indicates problems in attention and executive functioning that may underlie the behavior profile which primarily comprises impulsive behavior. Contrary to expectations based on previous (case) reports, no deficits were found in social cognitive functioning. These findings are important for counseling purposes, for tailored education planning, and for the development of personalized intervention.

Measuring the contribution of art therapy in multidisciplinary treatment of personality disorders: The construction of the Self-expression and Emotion Regulation in Art Therapy Scale (SERATS).

Despite the use of art therapy in clinical practice, its appreciation and reported beneficial results, no instruments are available to measure specific effects of art therapy among patients with personality disorders cluster B/C in multidisciplinary treatment. In the present study, we described the development and psychometric evaluation of the Self-expression and Emotion Regulation in Art Therapy Scale (SERATS). Structural validity (exploratory and confirmatory factor analysis), reliability, construct validity and sensitivity to change were examined using two independent databases (n = 335; n = 34) of patients diagnosed with personality disorders cluster B/C. This resulted in a nine-item effect scale with a single factor with a high internal reliability and high test-retest reliability; it demonstrated discriminant validity and sensitivity to change. In conclusion, the SERATS is brief and content-valid and offers objective and reliable information on self-expression and emotion regulation in art therapy among patients with personality disorders cluster B/C. Although more research on construct validity is needed, the SERATS is a promising tool to be applied as an effect scale and as a monitoring tool during art therapy treatment. © 2017 The Authors Personality and Mental Health Published by John Wiley & Sons Ltd.

Evaluating WAIS-IV structure through a different psychometric lens: structural causal model discovery as an alternative to confirmatory factor analysis.

OBJECTIVE: Since the publication of the WAIS-IV in the U.S. in 2008, efforts have been made to explore the structural validity by applying factor analysis to various samples. This study aims to achieve a more fine-grained understanding of the structure of the Dutch language version of the WAIS-IV (WAIS-IV-NL) by applying an alternative analysis based on causal modeling in addition to confirmatory factor analysis (CFA). The Bayesian Constraint-based Causal Discovery (BCCD) algorithm learns underlying network structures directly from data and assesses more complex structures than is possible with factor analysis. METHOD: WAIS-IV-NL profiles of two clinical samples of 202 patients (i.e. patients with temporal lobe epilepsy and a mixed psychiatric outpatient group) were analyzed and contrasted with a matched control group (N = 202) selected from the Dutch standardization sample of the WAIS-IV-NL to investigate internal structure by means of CFA and BCCD. RESULTS: With CFA, the four-factor structure as proposed by Wechsler demonstrates acceptable fit in all three subsamples. However, BCCD revealed three consistent clusters (verbal comprehension, visual processing, and processing speed) in all three subsamples. The combination of Arithmetic and Digit Span as a coherent working memory factor could not be verified, and Matrix Reasoning appeared to be isolated. CONCLUSIONS: With BCCD, some discrepancies from the proposed four-factor structure are exemplified. Furthermore, these results fit CHC theory of intelligence more clearly. Consistent clustering patterns indicate these results are robust. The structural causal discovery approach may be helpful in better interpreting existing tests, the development of new tests, and aid in diagnostic instruments.

Representation of the Cattell-Horn-Carroll Theory of Cognitive Abilities in the Factor Structure of the Dutch-Language Version of the WAIS-IV.

The Cattell-Horn-Carroll (CHC) theory of cognitive abilities has been guiding in the revision of the Wechsler Adult Intelligence Scale-Fourth edition (WAIS-IV). Especially the measurement of fluid reasoning (Gf) is improved. A total of five CHC abilities are included in the WAIS-IV subtests. Using confirmatory factor analysis, a five-factor model based on these CHC abilities is evaluated and compared with the four index scores in the Dutch-language version of the WAIS-IV. Both models demonstrate moderate fit, preference is given to the five-factor CHC model both on statistical and theoretical grounds. Evaluation of the WAIS-IV according to CHC terminology enhances uniformity, and can be important when interpreting possible sources of index discrepancies. To optimally assemblage CHC and WAIS-IV, more knowledge of the interaction of abilities is needed. This can be done by incorporating intelligence testing in neuropsychological assessment. Using this functional approach contributes to a better understanding of an individual's cognitive profile.

Predictors of Incidence, Remission and Relapse of Axis I Mental Disorders in Young Women: A Transdiagnostic Approach.

An understanding of etiological and maintaining factors of mental disorders is essential for the treatment of mental disorders, as well as mental health promotion and protection. The present study examines predictors of the incidence, remission and relapse of a wide range of Axis I mental disorders, using data from the Dresden Predictor Study. A sample of 1394 young German women completed questionnaires evaluating psychological factors (positive mental health, self-efficacy, life satisfaction, neuroticism, psychopathology and dysfunctional attitudes) and global assessment of functioning, as well as structured diagnostic interviews assessing incidence and change (remission, relapse) in mental disorders. Predictors were analysed using a multivariate logistic regression model. Significant factors for incidence of mental disorders included neuroticism and global functioning. A remitting course of mental disorders was predicted by positive mental health, self-efficacy and global assessment of functioning. Relapse was significantly predicted by neuroticism and dysfunctional attitudes. Results imply that mental health promotion is particularly important for women with high neuroticism and low functioning, as they tend to be at risk for incidence. Mental disorder treatment may benefit from strengthening positive mental health and functioning, as these factors promote remission. Relapse-prevention may benefit from attention to neuroticism and dysfunctional attitudes in order to reduce the likelihood of relapse. Copyright © 2016 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: Incidence of mental disorders in young women was predicted by neuroticism and low global functioning. There seems to be a need for preventive interventions addressing high neuroticism and low global functioning. Remission in young women was predicted by positive mental health. It may be helpful to include resource-based interventions, which can strengthen or support general positive mental health. Relapse in young women was predicted by two negative psychological factors: high neuroticism and reporting many dysfunctional attitudes. Psychotherapy addressing the characteristics and behaviour of neurotic patients might be beneficial. Interventions should also focus on addressing and changing dysfunctional attitudes.

Severe fatigue in type 1 diabetes: Exploring its course, predictors and relationship with HbA1c in a prospective study.

AIMS: To prospectively identify the course of severe fatigue, its predictors and the relationship with HbA1c in patients with type 1 diabetes. METHODS: 214 adult patients completed questionnaires on fatigue severity and fatigue-related factors at baseline. HbA1c was retrieved from medical records. After 43months, fatigue severity and HbA1c were reassessed in 194 patients. A logistic regression analysis was used to determine predictors of severe fatigue at follow-up with various cognitive-behavioral and clinical factors as potential predictors. The relationship between fatigue and HbA1c was investigated in a sub-analysis by differentiating between patients with suboptimal glucose control [HbA1c>7% (53mmol/mol)] and optimal glucose control [HbA1c⩽7% (53mmol/mol)]. RESULTS: The prevalence of severe fatigue was 40% at baseline and 42% at follow-up. In three out of four severely fatigued patients at baseline (76%), severe fatigue persisted over time. More depressive symptoms, more pain, sleep disturbances, lower self-efficacy concerning fatigue, less confidence in diabetes self-care, more fatigue severity at baseline and more diabetes complications predicted severe fatigue at follow-up. Over time, HbA1c at baseline was positively associated with fatigue severity at follow-up in both groups (suboptimal glucose control: r=.18, p<.05; optimal glucose control: r=.09, p<.05). CONCLUSIONS: About three quarters of fatigued[corrected] patients with type 1 diabetes suffer from persistent fatigue. Aside from the number of diabetes complications, no clinical factors explained the persistence of fatigue. HbA1c and fatigue were weakly associated in a sub-analysis. Since the strongest predictors of severe fatigue were cognitive-behavioral factors, behavioral interventions might be effective in decreasing fatigue.

Psychometric properties of the Positive Mental Health Scale (PMH-scale).

BACKGROUND: In recent years, it has been increasingly recognized that the absence of mental disorder is not the same as the presence of positive mental health (PMH). With the PMH-scale we propose a short, unidimensional scale for the assessment of positive mental health. The scale consists of 9 Likert-type items. METHODS: The psychometric properties of the PMH-scale were tested in a series of six studies using samples from student (n = 5406), patient (n = 1547) and general (n = 3204) populations. Factorial structure and measurement equivalence were tested with the measurement invariance testing. The factor models were analysed with the maximum likelihood procedure. Internal consistency was examined using Cronbach's alpha, test-retest reliability, convergent and divergent validity was examined by Pearson correlation. Sensitivity to (therapeutic) change was examined with the t-test. RESULTS: Results confirmed unidimensionality, scalar invariance across samples and over time, high internal consistency, good retest-reliability, good convergent and discriminant validity as well as sensitivity to therapeutic change. CONCLUSIONS: These findings suggest that the PMH-Scale indeed measures a single concept and allows us to compare scores over groups and over time. The PMH-scale thus is a brief and easy to interpret instrument for measuring PMH across a large variety of relevant groups.

Clinical validation of three short forms of the Dutch Wechsler Memory Scale-Fourth Edition (WMS-IV-NL) in a mixed clinical sample.

The reliability and validity of three short forms of the Dutch version of the Wechsler Memory Scale-Fourth Edition (WMS-IV-NL) were evaluated in a mixed clinical sample of 235 patients. The short forms were based on the WMS-IV Flexible Approach, that is, a 3-subtest combination (Older Adult Battery for Adults) and two 2-subtest combinations (Logical Memory and Visual Reproduction and Logical Memory and Designs), which can be used to estimate the Immediate, Delayed, Auditory and Visual Memory Indices. All short forms showed good reliability coefficients. As expected, for adults (16-69 years old) the 3-subtest short form was consistently more accurate (predictive accuracy ranged from 73% to 100%) than both 2-subtest short forms (range = 61%-80%). Furthermore, for older adults (65-90 years old), the predictive accuracy of the 2-subtest short form ranged from 75% to 100%. These results suggest that caution is warranted when using the WMS-IV-NL Flexible Approach short forms to estimate all four indices.

Fluid intelligence and executive functioning more alike than different?

OBJECTIVE: Fluid intelligence (Gf) has been related to executive functioning (EF) in previous studies, and it is also known to be correlated with crystallized intelligence (Gc). The present study includes representative measures of Gf, Gc, and EF frequently used in clinical practice to examine this Gf-EF relation. It is hypothesised that the Gf-EF relation is higher than the Gc-EF relation, and that working memory in particular (as a measure of EF) shows a high contribution to this relation. METHOD: Confirmatory factor analysis was performed on a mixed neuropsychiatric and non-clinical sample consisting of 188 participants, using the Kaufman Adolescent and Adult Intelligence Test, and three executive tasks of the Cambridge Neuropsychological Test Automated Battery, covering working memory, planning skills, and set shifting. RESULTS: The model fitted the data well [χ²(24)=35.25, p=0.07, RMSEA=0.050]. A very high correlation between Gf and EF was found (0.91), with working memory being the most profound indicator. A moderate to high correlation between Gc and EF was present. Current results are consistent with findings of a strong relation between Gf and working memory. CONCLUSION: Gf and EF are highly correlated. Gf dysfunction in neuropsychiatric patients warrants further EF examination and vice versa. It is discussed that results confirm the need to distinguish between specific versus general fluid/executive functioning, the latter being more involved when task complexity and novelty increase. This distinction can provide a more refined differential diagnosis and improve neuropsychiatric treatment indication.

Personality and psychopathology: mapping the MMPI-2-RF on Cloninger's psychobiological model of personality.

This study investigates the relationship between the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) and the Temperament and Character Inventory (TCI) in a combined data set (N = 491) of patients with a broad range of psychiatric disorders (n = 286) as well as alcohol use disorder (n = 205). We examined bivariate correlations between both measures. The MMPI-2-RF scales relate to the TCI dimensions as was hypothesized, and relationships between both measurements were largely similar for psychiatric patients and alcohol-dependent patients. Theoretical and clinical implications are considered.