Faculty Bibliography

Healthy parenting may be protective against the development of emotional psychopathology, particularly for children reared in stressful environments. Little is known, however, about the brain and behavioral mechanisms underlying this association, particularly during childhood and adolescence, when emotional disorders frequently emerge. Here, we demonstrate that psychological control, a parenting strategy known to limit socioemotional development in children, is associated with altered brain and behavioral responses to emotional conflict in 27 at-risk (urban, lower income) youth, ages 9-16. In particular, youth reporting higher parental psychological control demonstrated lower activity in the left anterior insula, a brain area involved in emotion conflict processing, and submitted faster but less accurate behavioral responses-possibly reflecting an avoidant pattern. Effects were not replicated for parental care, and did not generalize to an analogous nonemotional conflict task. We also find evidence that behavioral responses to emotional conflict bridge the previously reported link between parental overcontrol and anxiety in children. Effects of psychological control may reflect a parenting style that limits opportunities to practice self-regulation when faced with emotionally charged situations. Results support the notion that parenting strategies that facilitate appropriate amounts of socioemotional competence and autonomy in children may be protective against social and emotional difficulties.

The emergency department's role in a psychiatric crisis is to assess for safety, provide crisis interventions, reach a diagnosis, make decisions about disposition and treatment, and provide linkage to the next level of care within the hospital or in the community. The evaluation of children and adolescents involved in the child welfare system brings numerous additional challenges to this already-complex environment, including familial and systemic issues and an almost ubiquitous history of trauma. This article endeavors to increase understanding of child welfare-related issues and provides insight toward using a more trauma-informed and comprehensive approach that incorporates all these factors.

BACKGROUND:Little is known about the impact of prenatal maternal stress (PNMS) on the developmental trajectory of temperament and few studies have been able to incorporate a natural disaster as a quasi-experimental stressor. The current study investigated PNMS related to Superstorm Sandy ('Sandy'), a hurricane that struck the New York metropolitan area in October 2012, in terms of objective exposure during pregnancy, subjective stress reaction as assessed by maternal symptoms of post-traumatic stress, and their impact on the developmental changes in temperament during early childhood. METHOD:A subsample of 318 mother-child dyads was drawn from the Stress in Pregnancy Study. Temperament was measured at 6, 12, 18, and 24 months of age. RESULTS:Objective exposure was associated with greater High-Intensity Pleasure, Approach, Perceptual Sensitivity and Fearfulness, but lower Cuddliness and Duration of Orientation at 6 months. Objective exposure and its interaction with subjective stress reaction predicted developmental changes in temperament. In particular, objective exposure was linked to greater increases in Activity Level but decreases in High-Intensity Pleasure, Approach, and Fearfulness. The combination of objective exposure and subjective stress reaction was also associated with greater increases in Activity Level. LIMITATIONS:Temperament was measured solely via maternal report. Trimester-specific effects of Sandy on temperament were not examined. CONCLUSION:This is the first study to examine the effects of prenatal maternal exposure to a natural disaster on trajectories of early childhood temperament. Findings suggest that both objective stress exposure and subjective stress reaction in-utero predict developmental trajectories of temperament in early childhood.

Acute agitation in children and adolescents in the emergency department carries significant risks to patients and staff and requires skillful management, using both nonpharmacologic and pharmacologic strategies. Effective management of agitation requires understanding and addressing the multifactorial cause of the agitation. Careful observation and multidisciplinary collaboration is important. Medical work-up of agitated patients is also critical. Nonpharmacologic deescalation strategies should be first line for preventing and managing agitation and should continue during and after medication administration. Choice of medication should focus on addressing the cause of the agitation and any underlying psychiatric syndromes.

CONTEXT:Polytraumatization classes based on trauma endorsement patterns relate to distinct clinical outcomes. Person-centered approaches robustly evaluate the nature, and construct validity of polytraumatization classes. OBJECTIVE:Our review examined evidence for the nature and construct validity of lifespan polytraumatization typologies. DATA SOURCES:In September 2016, we searched Pubmed, PSYCINFO, PSYC ARTICLES, Academic Search Complete, PILPTS, Web of Science, CINAHL, Medline, PsycEXTRA, and PBSC. Search terms included "latent profile," "latent class," "latent analysis," "person-centered," "polytrauma," "polyvictimization," "traumatization," "lifetime," "cooccurring," "complex," "typology," "multidimensional," "sequential," "multiple," "subtype," "(re)victimization," "cumulative," "maltreatment," "abuse," and "stressor." Inclusionary criteria included: peer-reviewed; latent class/latent profile analyses (LCA/LPA) of lifespan polytrauma classes; adult samples of size greater than 200; only trauma types as LCA/LPA indicators; mental health correlates of typologies; and individual-level trauma assessment. Of 1,397 articles, nine met inclusion criteria. DATA EXTRACTION:Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, research assistants completed a secondary reference search, and independently extracted data with standardized coding forms. RESULTS:Three-class (n = 5) or four-class (n = 4) solutions were found. Seven studies found a class characterized by higher trauma endorsement (high-trauma). All studies found a class characterized by lower trauma endorsement (low-trauma), and predominance of specific traumas (specific-trauma; e.g., childhood maltreatment). High-trauma versus low-trauma classes and specific-trauma versus low-trauma classes differed on mental health correlates. CONCLUSION:Evidence supports the prevalence of a high-trauma class experiencing poorer mental health, and the detrimental impact of aggregated interpersonal and other traumas. We highlight the clinical importance of addressing polytraumatization classes, and comprehensively assessing the impact of all traumas.

OBJECTIVE:Obesity and depression frequently co-occur, and each increases risk for cardiovascular disease (CVD). This study tested whether a combined treatment, targeting obesity and depression simultaneously, would yield greater improvements in weight, mood, and CVD risk factors than treatments that targeted each disease individually. METHODS:Seventy-six participants with obesity and major depression were randomly assigned to (1) behavioral weight control (BWC), (2) cognitive behavioral therapy for depression (CBT-D), or (3) BWC combined with CBT-D. Participants were provided 18 group treatment sessions over 20 weeks. Mood, weight, and CVD risk were assessed at baseline and weeks 8 and 20, with a follow-up visit at week 46. RESULTS:At week 20, participants in combined treatment lost significantly (P < 0.02) more weight (5.2% ± 1.2%) than those assigned to CBT-D (0.8% ± 1.3%) and comparable amounts as those in BWC (3.5% ± 1.3%). Depression scores decreased significantly from baseline levels in each group, with no significant differences between groups. All three groups showed significant improvements in 10-year CVD risk, with no significant differences between groups. Groups did not differ significantly on any of these measures at week 46. CONCLUSIONS:BWC yielded short-term improvements in weight, mood, and CVD risk, comparable to a combined treatment that incorporated CBT-D. Results require replication with a larger sample size.

Face-to-face interaction between infants and their caregivers is a mainstay of developmental research. However, common laboratory paradigms for studying dyadic interaction oversimplify the act of looking at the partner's face by seating infants and caregivers face to face in stationary positions. In less constrained conditions when both partners are freely mobile, infants and caregivers must move their heads and bodies to look at each other. We hypothesized that face looking and mutual gaze for each member of the dyad would decrease with increased motor costs of looking. To test this hypothesis, 12-month-old crawling and walking infants and their parents wore head-mounted eye trackers to record eye movements of each member of the dyad during locomotor free play in a large toy-filled playroom. Findings revealed that increased motor costs decreased face looking and mutual gaze: Each partner looked less at the other's face when their own posture or the other's posture required more motor effort to gain visual access to the other's face. Caregivers mirrored infants' posture by spending more time down on the ground when infants were prone, perhaps to facilitate face looking. Infants looked more at toys than at their caregiver's face, but caregivers looked at their infant's face and at toys in equal amounts. Furthermore, infants looked less at toys and faces compared to studies that used stationary tasks, suggesting that the attentional demands differ in an unconstrained locomotor task. Taken together, findings indicate that ever-changing motor constraints affect real-life social looking.

The current state of emergency child and adolescent psychiatry includes common historical challenges to safe and effective care as well as recent innovations in multiple settings that increase the quality of that care. These include (1) enhancements within pediatric emergency departments (EDs), (2) specialized and dedicated child psychiatry emergency programs that are hospital based, (3) telepsychiatry programs that spread access to child psychiatric evaluation and treatment planning, and (4) community-based mobile programs diverting youth from EDs. Together, these highlight the work in North America over the past 5 years to improve the care of youth in psychiatric crisis.

OBJECTIVE:Little is known about the extent to which previous weeks' stressful events spill over and influence adolescents' abilities to derive insight from treatment sessions. Even less is known about factors that moderate clients' vulnerabilities to these spillover effects. The current study examined the spillover of negative interpersonal events to postsession insight and the role of difficulties in emotion regulation in this spillover effect. METHOD:Participants were 129 adolescents with moderate to severe depressive symptoms and suicidal ideation (Mage = 14.96, 83% female, 56% African American/Black) participating in a comparative efficacy trial of Attachment-Based Family Therapy (ABFT) and Family-Enhanced Nondirective Supportive Therapy (FE-NST). A within-subject mediation model tested presession negative affect as a mediator of spillover of past week's events on postsession insight. We then examined baseline difficulties in emotion regulation (DERS) as a between-subjects moderator of the mediation model. RESULTS:Negative affect partially mediated (44%) the spillover of the past week's negative events on adolescents' ratings of postsession insight (p = .03, 95% confidence interval, CI [-.09., -.002]). Baseline DERS increased adolescents' vulnerabilities to spillover effects (p = .01, 95% CI [-.28, -.03]). Negative interpersonal events from the past week influence presession negative affect and spill over to adolescents' abilities to gain insight from their treatment sessions. Adolescents who began treatment with greater DERS were particularly vulnerable to these spillover effects. Findings indicate the need for therapists to adapt sessions to individual differences in depressed and suicidal adolescents' exposure to negative interpersonal events preceding treatment and in their vulnerabilities to spillover and emotion dysregulation. (PsycINFO Database Record

RATIONALE:Preliminary evidence suggests that cannabidiol (CBD) may be effective in the treatment of neurodegenerative disorders; however, CBD has never been evaluated for the treatment of cognitive impairments associated with schizophrenia (CIAS). OBJECTIVE:This study compared the cognitive, symptomatic, and side effects of CBD versus placebo in a clinical trial. METHODS:This study was a 6-week, randomized, placebo-controlled, parallel group, fixed-dose study of oral CBD (600 mg/day) or placebo augmentation in 36 stable antipsychotic-treated patients diagnosed with chronic schizophrenia. All subjects completed the MATRICS Consensus Cognitive Battery (MCCB) at baseline and at end of 6 weeks of treatment. Psychotic symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS) at baseline and biweekly. RESULTS:There was no main effect of time or drug on MCCB Composite score, but a significant drug × time effect was observed (p = 0.02). Post hoc analyses revealed that only placebo-treated subjects improved over time (p = 0.03). There was a significant decrease in PANSS Total scores over time (p < 0. 0001) but there was no significant drug × time interaction (p = 0.18). Side effects were similar between CBD and placebo, with the one exception being sedation, which was more prevalent in the CBD group. CONCLUSIONS:At the dose studied, CBD augmentation was not associated with an improvement in MCCB or PANSS scores in stable antipsychotic-treated outpatients with schizophrenia. Overall, CBD was well tolerated with no worsening of mood, suicidality, or movement side effects. TRIAL REGISTRATION:https://clinicaltrials.gov/ct2/show/NCT00588731.