Faculty Bibliography

Children's maladaptive cognitive attributions may elicit affective reactions that contribute to depressive and anxious symptoms. This study investigated cognitive-affective pathways in depressive and anxious symptoms in a sample of 110 prepubertal children, evaluating children's specific appraisals of experiences of parental discipline as well as general attributional style, along with their hopelessness, self-esteem, and shame. Pathways toward depressive and anxious symptoms were tested simultaneously to identify potential unique etiological mechanisms. Results suggested that lower self-esteem strongly contributed to depressive and anxious symptoms, whereas shame related to depression only and hopelessness related to depression only marginally. Additionally, general negative attributional style and low sense of control over discipline related to all three affective elements. Lastly, low sense of discipline control directly predicted depressive symptoms, whereas beliefs that discipline was undeserved directly predicted anxious symptoms. Future work should continue to examine the role of children's discipline-specific attributions, which appear important in internalizing symptoms.

OBJECTIVE:This study describes the experiences of adult psychiatry residents working in an established faculty-led asylum clinic within a community-based, academic residency program at the Cambridge Health Alliance. METHODS:Eighteen psychiatry residents who participated in the asylum clinic were sent electronic surveys asking about their background and experience. Respondents' responses were collected anonymously. RESULTS:Sixteen out of 18 (89%) trainees responded. Thirteen respondents had a personal history with immigration. Fifty-three percent of residents wanted to utilize their professional standing to advance moral good. Writing up affidavits was noted to be challenging by nine (60%) of 15 trainees. Ninety-four percent (15/16) of trainees noted that they would be willing to perform future evaluations. Most noted that performing evaluations had a significant impact on their clinical practice and their conceptualization of their own roles as psychiatrists. CONCLUSIONS:Participating in asylum evaluations impacts residents' sense of themselves as psychiatrists and expands their views about psychiatrists' roles.

Over the past two decades, research on pediatric bipolar disorder has grown geometrically. The diagnosis of pediatric bipolar disorder was met with enthusiasm, which in healthy doses catalyzed change, and skepticism, which in good measure pushes for rigor. Skepticism led to productive questions about the phenomenology of pediatric bipolar disorder and how best to diagnose and treat it. With regard to prevalence, key questions included whether it was increasing over time, and whether it was limited to the United States. In 2011, we published a meta-analysis addressing the prevalence questions; results indicated that bipolar disorder manifested at statistically indistinguishable rates in youth community samples across the world. In their recent paper, Parry et al. examine the studies included in the 2011 meta-analysis using a qualitative approach. Their opinion piece represents a step backwards; every study has shortcomings, but in focusing on a dozen individual studies, Parry et al. fail to take into account the preponderance of evidence - literally thousands of articles across countries, cohorts and methodologies - that support the existence of bipolar disorder in both prepubescent youth and adolescents. This commentary addresses misperceptions regarding the diagnosis of bipolar disorder in youth, particularly with regard to cross-informant agreement, to present converging data from international sources regarding the onset of bipolar disorder in childhood, and to correct the false claim that pediatric bipolar disorder is controversial. As clinicians and researchers, we have an obligation to do what we can to improve the lives of youth affected by mental illness. Denying the existence of a serious mood disorder will not serve the best interests of young people and will perpetuate the long delays many experience before getting an accurate diagnosis, appropriate treatment, and a fair chance at a good quality of life.

Spectral imaging is a ubiquitous tool in modern biochemistry. Despite acquiring dozens to thousands of spectral channels, existing technology cannot capture spectral images at the same spatial resolution as structural microscopy. Due to partial voluming and low light exposure, spectral images are often difficult to interpret and analyze. This highlights a need to upsample the low-resolution spectral image by using spatial information contained in the high-resolution image, thereby creating a fused representation with high specificity both spatially and spectrally. In this paper, we propose a framework for the fusion of co-registered structural and spectral microscopy images to create super-resolved representations of spectral images. As a first application, we super-resolve spectral images of retinal tissue imaged with confocal laser scanning microscopy, by using spatial information from structured illumination microscopy. Second, we super-resolve mass spectroscopic images of mouse brain tissue, by using spatial information from high-resolution histology images. We present a systematic validation of model assumptions crucial towards maintaining the original nature of spectra and the applicability of super-resolution. Goodness-of-fit for spectral predictions are evaluated through functional R² values, and the spatial quality of the super-resolved images are evaluated using normalized mutual information.

Exposure to traumatic events early in life has been associated with significant adverse neurodevelopmental consequences.^1,2 Ideally, protecting children from trauma would prevent these consequences. Unfortunately, once a child is exposed to early trauma, the only means of prevention requires implementing effective interventions toward the mechanisms known to have caused the consequences. Therefore, it is imperative to carefully define the true mechanistic pathways from which the neurodevelopmental consequences of early trauma result. The process of determining the correct pathway(s) is not a trivial matter, as is made clear from a valiant effort reported in this issue of the Journal titled, "Early Sexual Trauma Exposure and Neural Response Inhibition in Adolescence and Young Adults: Trajectories of Frontal Theta Oscillations During a Go/No-Go Task."³ This editorial reviews the effort to infer causal mechanism in this article, and introduces a literature that can improve the field's capacity to infer causes from observational data.

OBJECTIVE:Network meta-analyses (NMAs) are gaining traction as the preferred method for evidence synthesis of intervention studies. This review aimed to summarize the basics of NMAs and conduct a meta-review of available NMAs on the treatment of child and adolescent psychiatric disorders by appraising their quality. METHOD/METHODS:PubMed (Medline), PsycInfo, Embase, Ovid Medline, and Web of Knowledge were systematically searched (last update January 9, 2018). The quality of each included NMA was appraised using the AMSTAR-2 tool and the PRISMA-NMA checklist, which includes specific items for NMAs. RESULTS:Eighteen NMAs (6 on attention-deficit/hyperactivity disorder; 4 on psychotic disorders; 2 on depression; 2 on anxiety disorders; 1 on obsessive-compulsive disorder; 1 on disruptive behavior disorder, 1 on bipolar disorder, and 1 on antipsychotics across disorders) were retrieved. Results from the AMSTAR-2 assessment showed that only 27% of appraised NMAs were rated as moderate quality; most were rated as low (33%) or critically low (40%) quality. Only 3 of the appraised NMAs reported on all PRISMA-NMA items specific for NMAs; the network structure was graphically presented in most NMAs (80%), and inconsistency was described in only 47%. CONCLUSION/CONCLUSIONS:Given the paucity of head-to-head trials in child and adolescent psychiatry, NMAs have the potential to contribute to the field, because they provide evidence-based hierarchies for treatment decision making, even in the absence of trials directly comparing at least 2 treatments. However, because of important limitations in the included NMAs, additional methodologically sound NMAs are needed to inform future guidelines and clinical practice in child and adolescent psychiatry.