October 2014 article summaries
1. Empirically Supported Psychological Treatments: The Challenge of Evaluating Clinical Innovations
Dawson Church, PhD, David Feinstein, PhD, Julie Palmer-Hoffman, MA, Phyllis K. Stein, PhD, and Anthony Tranguch, MD, PhD
Clear and transparent standards are required to establish whether a therapeutic method is evidence based.” Even when research demonstrates a method to be efficacious, it may not become available to patients who could benefit from it, a phenomenon known as the “translational gap.” Only 30% of therapies cross the gap, and the lag between empirical validation and clinical implementation averages 17 years. To address these problems, Division 12 of the American Psychological Association published a set of standards for “empirically supported treatments” in the mid-1990s that allows the assessment of clinical modalities. This article reviews these criteria, identifies their strengths, and discusses their impact on the translational gap, using the development of a clinical innovation called Emotional Freedom Techniques (EFT) as a case study. Twelve specific recommendations for updates of the Division 12 criteria are made based on lessons garnered from the adoption of EFT within the clinical community.
2. Apathy and Dementia. Nosology, Assessment and Management
Gabriele Cipriani, MD, Claudio Lucetti, MD, Sabrina Danti, PsyD, and Angelo Nuti, MD
To explore the phenomenon of apathy in people with dementia, we searched the PubMed and Google Scholar electronic databases for original research and review articles on apathetic behaviors in patients with dementia using the search terms “apathy, behavioral and psychological symptoms, dementia, Alzheimer’s disease, Frontotemporal dementia, Dementia associated with Parkinson’s disease, Huntington’s disease, Vascular dementia”. Some nosological aspects, neurobiological basis, assessment, and potential benefits of non-pharmacologic and pharmacologic interventions of apathy in dementia are discussed.
3. Coping With Stigma by Association and Family Burden Among Family Members of People With Mental Illness
Remko L.M. van der Sanden, MSc, Sarah E. Stutterheim, PhD, John B. Pryor, PhD, Gerjo Kok, PhD, and Arjan E.R. Bos, PhD
In this study, we explored stigma by association, family burden, and their impact on the family members of people with mental illness. We also studied the ways in which family members coped with these phenomena. We conducted semistructured interviews with 23 immediate family members of people with mental illness. Participants reported various experiences of stigma by association and family burden. Social exclusion, being blamed, not being taken seriously, time-consuming caregiving activities, and exhaustion appeared to be the predominant forms of stigma by association and family burden experienced by the participants. The participants used problem-focused and emotion-focused coping strategies, separately or simultaneously, to cope with the negative impact of stigma by association and family burden.
4. Attention-Deficit/Hyperactivity Disorder and Adverse Health Outcomes in Adults
Thomas J. Spencer, MD, Stephen V. Faraone, PhD, Laura Tarko, MPH, Katie McDermott, BS, and Joseph Biederman, MD
The main aim of this study was to assess the impact of ADHD on lifestyle behaviors and measures of adverse health risk indicators. Subjects were 100 adults with untreated ADHD and 100 adults without ADHD of similar age and sex. Unhealthy lifestyle indicators included assessments of bad health habits, frequency of visits to healthcare providers, and follow through with recommended prophylactic tests. Assessments of adverse health risk indicators included measurements of cardiovascular and metabolic parameters, weight, body mass index, and waist circumference. No differences were identified in health habits between subjects with and without ADHD, but robust differences were found in a wide range of adverse health risk indicators. ADHD is associated with an adverse impact in health risk indicators well known to be associated with high morbidity and mortality.
5. Short-Term Cognitive Effects After Recovery From a Delirium in a Hospitalized Elderly Sample
Ruth E. Mark, PhD, Noortje Muselaers, MSc, Hetty Scholten, PhD, Anton van Boxtel, MSc, and Trudy Eerenberg, MD, PhD
The aim of this study was to examine early cognitive performance after a delirium in elderly general hospital patients. Patients were divided into a group with delirium (n = 47) and a control (n = 25) group. One week before discharge and after delirium had cleared in the first group, all patients completed a neuropsychological test battery (The Cambridge Cognitive Examination-Revised [CAMCOG-R]). Group differences in cognitive performance were analyzed adjusting for differences in baseline sociodemographic and clinical variables. Adjusting for group differences in baseline ariables, the delirium group performed significantly worse than the control group on CAMCOG-R; its subdomains language, praxis, and executive functioning; and on Mini Mental State Examination derived from CAMCOG-R.
6. Using the Persian-Language Version of the Beck Depression Inventory–II (BDI-II-Persian) for the Screening of Depression in Students. Susan Vasegh, MD, Nafiseh Baradaran, MD
The aim of this study was to empirically confirm any cutoff points on the Beck Depression Inventory–II for screening depression among university students. Our subjects were 400 students from Ilam University (Iran). On the basis of a diagnostic interview checklist, the subjects were differentiated whether they were major depressive syndrome positive (MDS+; i.e., fulfill criteria A and C of major depressive episode Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria) or significant depression positive (SD+;having depressed mood or anhedonia that caused significant distress or dysfunction). According to receiver operating characteristic curves obtained, the cutoff point of 22 or greater was the most suitable to screen MDS, whereas for screening milder but clinically significant depression (i.e., having depressed mood or anhedonia that caused significant distress or dysfunction), the cutoff point of 14 or greater was the best.
7. Speech Prosody Abnormalities and Specific Dimensional Schizotypy Features: Are Relationships Limited to Men?
Jeffrey S. Bedwell, PhD, Alex S. Cohen, PhD, Benjamin J. Trachik, MA, Andrew E. Deptula, MS, and Jonathan C. Mitchell, MS
The current study examined 44 young adults (50% men) who were recruited to represent a continuous range of schizotypy. Speech samples were digitally recorded during autobiographical narratives and analyzed for prosody. In the male participants, variability of fundamental frequency and variability of intensity were each negatively related to the Schizotypal Personality Questionnaire (SPQ) ideas of reference subscale, whereas SPQ suspiciousness was related to a greater number of utterances, and SPQ odd behavior was related to a greater number of pauses. The relationships were restricted to men, and not significant in women.
8. Depersonalization in Patients With Persecutory Delusions
Emma Cernis, MSc, Graham Dunn, PhD, Helen Startup, PhD, DClinPsy, David Kingdon, FRCPsych, Gail Wingham, BSc, Katherine Pugh, DClinPsych, Jacinta Cordwell, DClinPsy, Helen Mander, DClinPsy, and Daniel Freeman, PhD, DClinPsy
Delusions are, in part, attempts to explain confusing anomalous The aims of this study were to assess the presence of depersonalization in patients with persecutory delusions and to examine associations with levels of paranoia and worry. Fifty patients with a current persecutory delusion completed measures of depersonalization, psychotic symptoms, and worry. Depersonalization experiences were common: 30 patients (60%) each reported at least 10 different depersonalization symptoms occurring often. A greater number of depersonalization experiences were associated with higher levels of paranoia and worry. The positive association of worry and paranoia became nonsignificant when controlling for depersonalization. Overall, depersonalization may be common in patients with persecutory delusions and is associated with the severity of paranoia. The results are consistent with the view that worry may cause depersonalization experiences that contribute to the occurrence of paranoid thoughts.
9.The Impact of Comorbid Depressive and Anxiety Disorders on Severity of Anorexia Nervosa in Adolescent Girls
Ayelet Brand-Gothelf, MD, Shani Leor, PhD, Alan Apter, MD, and Silvana Fennig, MD
We examined the impact of comorbid depression and anxiety disorders on the severity of anorexia nervosa (AN) in adolescent girls. Adolescent girls with AN (N = 88) were divided into one group with and another group without comorbid disorders, and selected subjective and objective measures of illness severity were compared between the two groups. The comorbid group had significantly higher scores than the noncomorbid group for all four subscales and total scores of the Eating Disorders Examination as well as for all Eating Disorders Inventory–2 subscales, except for bulimia. The comorbid group also had significantly more suicide attempts and hospitalizations compared with the noncomorbid group. There were no significant group differences for the lowest ever body mass index, duration of AN symptoms, and age at AN onset.
10. The Relationship of Life Stressors, Mood Disorder, and Health Care Utilization in Primary Care Patients Referred for Integrated Behavioral Health Services
Elizabeth Sadock, MS, Stephen M. Auerbach, PhD, Bruce Rybarczyk, Phd, Arpita Aggarwal, MD, Autumn Lanoye, MS
Exposure to stressful life events, mood disorder, and health care utilization were evaluated in 102 low-income, primarily minority patients receiving behavioral health and medical services at a safety-net primary care clinic. Exposure to major stressors was far higher in this sample than in the general population, with older patients having lower stress scores. Proportions of patients who met the criteria for clinical depression and anxiety were higher than in normative samples of primary care patients. Stress exposure was higher in the patients who met the criterion for clinical anxiety but was unrelated to clinical depression. Contrary to expectation, anxiety, depression, or stress exposure was not related to service utilization. Latter findings are discussed in terms of the influence of the provision of behavioral health services, the highly skewed distribution of major stressor scores, and the likely greater influence of individual differences in minor stressor exposure on utilization in this population.