Coping with Administrative Workload: a Pilot Study in the Usefulness of a Workshop for Psychiatric Trainees.

OBJECTIVE: Administrative workload may have detrimental effects on medical postgraduate trainee satisfaction, capacity, and quality of care. Best-practice guidelines to help trainees cope have yet to be developed. This study explores perceptions of factors that influence the experience or amount of administrative workload at the personal and workplace level and evaluates the usefulness of a workshop on coping with this workload. METHODS: A workshop was developed based on the Job Demands-Resources model, including a survey on perceptions of administrative workload; presentation on coping at personal (e.g., time management) and workplace (e.g., dealing with institutional rules) levels; personal plan of change during a group discussion; and reflective questionnaire after the session and again after 2 months. Perceptions of psychiatry trainee participants (N = 48) were collected. RESULTS: Trainees estimated they spent half their time on administration (average 50%, SD = 15%). They wanted to spend less time (average 23%, SD = 11%) on most administrative duties, except for health record keeping. Personal factors that trainees experienced as helpful to cope included time management and analytical skills. Perfectionism was perceived as impeding. Supportive job factors included helpful supervisors, competent administrative staff, trust in a team, allocated timeslots, and information technology support. High workload and cumbersome procedures were mentioned as impeding. On average, trainees rated the workshop quality and the likelihood of bringing change to their practice with a 7 out of 10. CONCLUSION: Psychiatry trainees' participation in a workshop on coping with administrative load during their training may be a worthwhile investment in the long term.

The effect of attenuating noradrenergic neurotransmission by clonidine on brain activity measures of visuospatial attention.

OBJECTIVE: In the current study, we investigated the role of noradrenaline in directing (bias) and disengagement of visuospatial attention. METHODS: We assessed the effect of clonidine on event-related brain potential (ERP) reflections of bias and disengagement in a double-blind placebo-controlled crossover design. An initial dose of 200-µg clonidine was replaced by 100 µg because of marked side effects. Twenty-one healthy male participants performed the visual-spatial cueing task while an electroencephalogram (EEG) was recorded. The behavioral output is the validity effect (benefit of cueing in terms of reaction time to targets). ERP indices for bias were the cue-related early directing attention negativity and late directing attention positivity, and the target-elicited P1 and N1 modulations by validity ('validity-effect'). The ERP index for disengagement was the target-elicited 'late positive deflection' modulation by validity. Behavioral analyses were performed on 16 participants, electrophysiological analyses on a subset (n=9). RESULTS: Clonidine attenuated the N1 effect, albeit in a subsample. Neither cue-elicited ERPs nor the behavioral validity effect were affected. Clonidine-induced blood pressure reduction was correlated with the reduction of the late positive deflection effect under clonidine. CONCLUSION: Clonidine attenuated the result of bias in a subsample and may have a modulating effect on disengagement.

Living on Site While Renovating; Flexible Instructional Design of Post-Graduate Medical Training.

Background: Developing theoretical courses for post-graduate medical training that are aligned to current workplace-based learning practices and adaptive to change in the field is challenging, especially in (sub) specialties where time for re-design is limited and needs to be performed while education continues. Approach: An instructional design method was applied based on flexible co-design to improve post-graduate theoretical courses in child and adolescent psychiatry (CAP) in the Netherlands. In four phases over a period of three years, courses were re-designed at a national level. Evaluation: Once common vision and learning goals were agreed upon and the prototype was developed (phases 1 and 2), the first courses could be tested in daily practice (phase 3). Phase 4 refined these courses in brief iterative cycles and allowed for designing additional courses building on and adding to previous experiences in brief iterative cycles. The resulting national theoretical courses re-allocated resources previously spent on a local level using easily accessible online tools. This allowed trainees to align content with their clinical rotations, personal preferences and training schedules. Reflection: The development of theoretical courses for post-graduate medical training in smaller medical (sub-)specialties with limited resources may profit from a flexible instructional design method. We consider the potential merit of such a method to other medical specialties and other (inter-)national efforts to develop theoretical teaching courses. A longer-term implementation evaluation is needed to show to what extent the investment made in the re-design proves to be future-proof and enables rapid adaptation to changes in the field.

Do Distinct Groups of Reactively and Proactively Aggressive Children Exist? A Confirmatory Latent Profile Approach.

The present study examined whether there are distinct groups of children with reactive versus proactive motives for their aggressive behavior. We extended previous research by using a person-based analytical approach on data from a questionnaire assessing children's motives independently from the severity of their aggression. Two competing hypotheses were tested. The both subtypes hypothesis holds that both reactive and proactive subtypes exist, as well as a mixed subtype. The reactive only hypothesis holds that only reactive and mixed subtypes exist. Hypotheses were tested on existing data from a community sample of children displaying aggression (Study 1: n = 228, ages 10-13, 54% boys), and two clinical samples of children with aggressive behavior problems (Study 2: n = 115, ages 8-13, 100% boys; Study 3: n = 123, ages 6-8, 78% boys). Teachers reported on children's reactive and proactive motives. We selected measures available from peers, parents, teachers, and children themselves to compare the supported subtypes on variables that previous literature suggests uniquely correlate with reactive versus proactive aggression. Confirmatory latent profile analyses revealed that the both subtypes hypothesis best fit the data of all three samples. Most children were classified as reactive (55.7-61.8% across samples), with smaller percentages classified as proactive (10.4-24.1%) and mixed (18.0-33.9%). However, these subtypes only differed in expected directions on 7 out of 34 measures. Overall, results support the existence of both reactive and proactive subtypes of aggressive children, but the distinctiveness of these subtypes in terms of social-emotional characteristics warrants further study.

Dopaminergic and noradrenergic manipulation of anticipatory reward and probability event-related potentials.

Predicting what will happen in the future in terms of potential reward is essential in daily life. The aim of the current study was to investigate the neurotransmitter systems involved in the anticipation of reward value and probability. We hypothesized that dopaminergic and noradrenergic antagonism would affect anticipation of reward value and probability, respectively. Twenty-three healthy participants were included in a haloperidol (2 mg) × clonidine (0.150 mg) × placebo cross-over design and subjected to a Go/NoGo experimental task during which cues signaled the probability of subsequent target appearance. Reward value (amount of money that could be won for correct and fast responding to the target) as well as probability of target appearance was orthogonally manipulated across four task blocks. Cue-elicited EEG event-related potentials were recorded to assess anticipation of value and probability, respectively. The processing of reward value was affected by dopaminergic antagonism (haloperidol), as evidenced by reduction of the reward-related positivity and P300 to reward cues. This reduction was specifically significant for subjects with high baseline dopamine levels for the P300 and most pronounced for these subjects for the reward-related positivity. In contrast, the processing of reward probability was affected by noradrenergic antagonism (clonidine). In addition, both drugs reduced overall performance (omission rate, response speed variability). We conclude that at least anticipation of reward value and probability, respectively, is specifically affected by dopaminergic versus noradrenergic antagonism.

Proactive aggression in early school-aged children with externalizing behavior problems: A longitudinal study on the influence of empathy in response to distress.

The course of proactive aggressive behavior may be affected by empathy in response to sadness and distress of others. The aim of the current study is to examine empathy in response to sadness and distress and its relation to proactive and reactive aggression in a clinical sample of children with externalizing behavior problems. At baseline (T1) and 12 months later (T2), parents and teachers of 104 six- and seven-year-old children completed the Instrument for Reactive and Proactive Aggression. At T1, parents and teachers also reported empathy in response to sadness and distress on the Griffith Empathy Measure. Findings show that low levels of parent-reported empathy at baseline were specifically associated with high parent-reported proactive aggression but not with reactive aggression. Similarly, low teacher-reported empathy was specifically related to high teacher-reported proactive aggression. Furthermore, high parent-reported but not teacher-reported empathy at baseline was associated with low proactive aggression at 12 months after controlling for proactive aggression at baseline. The conclusions support the notion that in the study of the course of aggression in clinical groups, the distinction between proactive and reactive aggression as well as the study of empathy in response to distress is relevant for a better understanding and might be taken into account in the development of future interventions. (PsycINFO Database Record

Haloperidol 2 mg impairs inhibition but not visuospatial attention.

RATIONALE: The dopaminergic system has been implicated in visuospatial attention and inhibition, but the exact role has yet to be elucidated. Scarce literature suggests that attenuation of dopaminergic neurotransmission negatively affects attentional focusing and inhibition. To the best of our knowledge, this is the first study that evaluated the effect of dopaminergic antagonism on stopping performance. METHODS: Dopaminergic neurotransmission was attenuated in 28 healthy male participants by using 2 mg haloperidol. A repeated-measures placebo-controlled crossover design was implemented, and performance indices of attention and inhibition were assessed in the visual spatial cueing task (VSC) and stop signal task (SST). Additionally, the effect of haloperidol on motoric parameters was assessed. It was expected that haloperidol as contrasted to placebo would result in a reduction of the "validity effect," the benefit of valid cueing as opposed to invalid cueing of a target in terms of reaction time. Furthermore, an increase in stop signal reaction time (SSRT) in the SST was expected. RESULTS AND CONCLUSION: Results partially confirmed the hypothesis. Haloperidol negatively affected inhibitory motor control in the SST as indexed by SSRT, but there were no indications that haloperidol affected bias or disengagement in the VSC task as indicated by a lack of an effect on RTs. Pertaining to secondary parameters, motor activity increased significantly under haloperidol. Haloperidol negatively affected reaction time variability and errors in both tasks, as well as omissions in the SST, indicating a decreased sustained attention, an increase in premature responses, and an increase in lapses of attention, respectively.

Empathy and empathy induced prosocial behavior in 6- and 7-year-olds with autism spectrum disorder.

The present study aimed to assess empathy and prosocial behavior in 6-7 year old children with autism spectrum disorders (ASDs). Results showed, first, lower levels of parent- and teacher-rated cognitive empathy, and similar levels of affective empathy in children with ASD compared to typically developing (TD) children. Second, emotion recognition for basic emotions, one aspect of cognitive empathy, in a story task was adequate in ASD children, but ASD children with severe impairments in social responsiveness had difficulties in recognizing fear. Third, prosocial behavior in response to signals of distress of a peer in a computer task was similar in ASD as in TD children. In conclusion, early elementary school children with ASD show specific impairments in cognitive empathy.

Facial mimicry in 6-7 year old children with disruptive behavior disorder and ADHD.

BACKGROUND: Impairments in facial mimicry are considered a proxy for deficits in affective empathy and have been demonstrated in 10 year old children and in adolescents with disruptive behavior disorder (DBD). However, it is not known whether these impairments are already present at an earlier age. Emotional deficits have also been shown in children with attention-deficit/hyperactivity disorder (ADHD). AIMS: To examine facial mimicry in younger, 6-7 year old children with DBD and with ADHD. METHODS: Electromyographic (EMG) activity in response to emotional facial expressions was recorded in 47 children with DBD, 18 children with ADHD and 35 healthy developing children. RESULTS: All groups displayed significant facial mimicry to the emotional expressions of other children. No group differences between children with DBD, children with ADHD and healthy developing children were found. In addition, no differences in facial mimicry were found between the clinical group (i.e., all children with a diagnosis) and the typically developing group in an analysis with ADHD symptoms as a covariate, and no differences were found between the clinical children and the typically developing children with DBD symptoms as a covariate. CONCLUSION: Facial mimicry in children with DBD and ADHD throughout the first primary school years was unimpaired, in line with studies on empathy using other paradigms.

The effect of noradrenergic attenuation by clonidine on inhibition in the stop signal task.

Understanding the neuropharmacology of inhibition is of importance to fuel optimal treatment for disorders such as Attention Deficit/Hyperactivity Disorder. The aim of the present study was to assess the effect of noradrenergic antagonism by clonidine on behavioral-performance and brain-activity indices of inhibition. A placebo-controlled, double-blind, randomized, crossover design was implemented. Male (N=21) participants performed in a visual stop signal task while EEG was recorded under clonidine in one session and under placebo in another. We expected that 100 µg clonidine would have a negative effect on EEG indices of inhibition, the Stop N2 and Stop P3. Furthermore, we expected that clonidine would negatively affect the behavioral measure of inhibition, the stop signal reaction time (SSRT). Behavioral analyses were performed on data of 17 participants, EEG analyses on a subset (N=13). Performance data suggested that clonidine negatively affected attention (response variability, omissions) without affecting inhibition as indexed by SSRT. Electrophysiological data show that clonidine reduced the Stop P3, but not the Stop N2, indicating a partial negative effect on inhibition. Results show that it is unlikely that the Stop P3 reduction was related to the effect of clonidine on lapses of attention and on peripheral cardiovascular functioning. In conclusion, the current dose of clonidine had a negative effect on attention and a partial effect on inhibitory control. This inhibitory effect was restricted to the dorsal region of the prefrontal cortex (presumably the superior frontal gyrus) as opposed to the ventral region of the prefrontal cortex (right inferior frontal gyrus).

Intranasal oxytocin increases fathers' observed responsiveness during play with their children: a double-blind within-subject experiment.

Recent correlational studies showed that oxytocin is associated with parenting style in humans as in other mammals. Here the first double-blind, placebo-controlled, within-subject experiment with intranasal oxytocin administration is presented. Subjects were 17 fathers with their toddler, observed in two play sessions of 15 min each with an intervening period of 1 week. In the oxytocin condition fathers were more stimulating of their child's exploration than in the placebo condition, and they tended to show less hostility. Parent training experiments might be combined with intranasal oxytocin administration to test differential and cumulative effects of traditional, interaction-focused versus pharmaceutical treatments.