Faculty Bibliography

This editorial discuses about psychiatrists. Editor says psychiatrists were once called alienists. It's an interesting word, in some ways more accurate than the Greek portmanteau word psychiatrist, which combines "doctor" (iatros) with a diffuse evocation of spirit, soul, and mind (psyche), a reminder of the uncertainty about, and the magnitude of, what we're treating. Alienist speaks to the absolute stigma of difference afforded the mentally ill: strangers, the estranged, visitors from another world who do not belong, less familiar than animals. Editor says that in this month's Book Forum, they encounter people who are reputedly alienated-the traumatized, the autistic, the hated parent-from writers defying pat notions of alienation and reconsidering the boundaries of recognition.

This article provides an overview of the books featured in the Book Forum section of the present issue of Journal of the American Academy of Child & Adolescent Psychiatry. The books seek to understand what one can gain from appreciating the reality of children's immersion in media. The power of the media is enormous for all. Its power comes not from how fantastical or extraordinary or strange it can be, but from how real it is. It is always tempting to think of the media as a vast, undulating metaphor for humanity, but it is not representing humanity: it is humanity.

In this month's Book Forum, the question is raised again: Where does love come from? Francesco Ferrari reviews an academic text on romantic love, full of theories and intellectual curiosity about this most important of topics, and Matthew J. Baker reviews a book that comes at the question from another angle, in a therapeutic guide book for daughters of mothers "who cannot love."

This article provides an overview of the two books presented in the issue Journal of the American Academy of Child & Adolescent Psychiatry. The first book, Being a Teen: Everything Teen Girls and Boys Should Know About Relationships, Sex, Love, Health, Identity, and More By Jane Fonda is the culmination of the author's experience with teens and what the author believes teens need to know. The second book, Healing After Parent Loss in Childhood and Adolescence: Therapeutic Interventions and Theoretical Considerations edited by Phyllis Cohen, K. Mark Sossin, and Richard Ruth is a new volume dedicated to clinical work with children and adolescents who have lost a parent to death. Sickles reviews a book of advice for teens, and Weis reviews a new text describing therapeutic interventions for children after the loss of a parent.

This editorial discuses the this month's Book Forum, in which we go back to the basics, to topics that are the roots of our field: case formulation, anxiety in children, and autism. The richness, the debates, and the complexities of the books and reviews speak to the exciting challenges we face in our day-to-day work and reflect the confounding magnificence of the rugrats, Minecraft addicts, and pierced teens we meet every day.

Facial emotion-recognition difficulties have been reported in school-aged children with behavior problems; little is known, however, about either this association in preschool children or with regard to vocal emotion recognition. The current study explored the association between facial and vocal emotion recognition and behavior problems in a sample of 3 to 6-year-old children. A sample of 57 children enriched for risk of behavior problems (41 were recruited from the general population while 16 had been referred for behavior problems to local clinics) were each presented with a series of vocal and facial stimuli expressing different emotions (i.e., angry, happy, and sad) of low and high intensity. Parents rated children's externalizing and internalizing behavior problems. Vocal and facial emotion recognition accuracy was negatively correlated with externalizing but not internalizing behavior problems independent of emotion type. The effects with the externalizing domain were independently associated with hyperactivity rather than conduct problems. The results highlight the importance of using vocal as well as facial stimuli when studying the relationship between emotion-recognition and behavior problems. Future studies should test the hypothesis that difficulties in responding to adult instructions and commands seen in children with attention deficit/hyperactivity disorder (ADHD) may be due to deficits in the processing of vocal emotions.

Deficits in emotion processing, a known clinical feature of major depressive disorder (MDD), have been widely investigated using emotional face paradigms and neuroimaging. However, most studies have not accounted for the high inter-subject variability of symptom severity. Similarly, only sparse research has focused on MDD in adolescence, early in the course of the illness. Here we sought to investigate neural responses to emotional faces using both categorical and dimensional analyses with a focus on anhedonia, a core symptom of MDD associated with poor outcomes. Nineteen medication-free depressed adolescents and 18 healthy controls (HC) were scanned during presentation of happy, sad, fearful, and neutral faces. ANCOVAs and regressions assessed group differences and relationships with illness and anhedonia severity, respectively. Findings included a group by valence interaction with depressed adolescents exhibiting decreased activity in the superior temporal gyrus (STG), putamen and premotor cortex. Post-hoc analyses confirmed decreased STG activity in MDD adolescents. Dimensional analyses revealed associations between illness severity and altered responses to negative faces in prefrontal, cingulate, striatal, and limbic regions. However, anhedonia severity was uniquely correlated with responses to happy faces in the prefrontal, cingulate, and insular regions. Our work highlights the need for studying specific symptoms dimensionally in psychiatric research.

A long-standing hypothesis termed "Hebbian plasticity" suggests that memories are formed through strengthening of synaptic connections between neurons with correlated activity. In contrast, other theories propose that coactivation of Hebbian and neuromodulatory processes produce the synaptic strengthening that underlies memory formation. Using optogenetics we directly tested whether Hebbian plasticity alone is both necessary and sufficient to produce physiological changes mediating actual memory formation in behaving animals. Our previous work with this method suggested that Hebbian mechanisms are sufficient to produce aversive associative learning under artificial conditions involving strong, iterative training. Here we systematically tested whether Hebbian mechanisms are necessary and sufficient to produce associative learning under more moderate training conditions that are similar to those that occur in daily life. We measured neural plasticity in the lateral amygdala, a brain region important for associative memory storage about danger. Our findings provide evidence that Hebbian mechanisms are necessary to produce neural plasticity in the lateral amygdala and behavioral memory formation. However, under these conditions Hebbian mechanisms alone were not sufficient to produce these physiological and behavioral effects unless neuromodulatory systems were coactivated. These results provide insight into how aversive experiences trigger memories and suggest that combined Hebbian and neuromodulatory processes interact to engage associative aversive learning.