Faculty Bibliography

We examined whether error monitoring, operationalized as the degree to which individuals slow down after committing an error (i.e., posterror slowing), is differentially important in the learning of rule-based versus information-integration category structures. Rule-based categories are most efficiently solved through the application of an explicit verbal strategy (e.g., "sort by color"). In contrast, information-integration categories are believed to be learned in a trial-by-trial, associative manner. Our results indicated that posterror slowing predicts enhanced rule-based but not information-integration category learning. Implications for multiple category-learning systems are discussed.

BACKGROUND: Advanced paternal age (APA) is associated with increased risk for schizophrenia, but its effect on treatment response has not been longitudinally studied. METHODS: Association of parental ages at the time of the child's birth with age of onset, initial symptom severity and treatment response (to placebo and three different weight-based doses of paliperidone ER) in adolescents with schizophrenia was assessed in a post-hoc analysis using data from a 6-week double-blind study, the primary results of which are published (NCT00518323). RESULTS: The mean (SD) paternal age was 29.2 (6.2) years, range (16-50) and maternal age was 26.8 (5.7) years, range (17-42) at childbirth for the 201 adolescents (ages 12-17years) included in the analysis. While parental ages were uncorrelated with age of onset or initial symptom severity, both maternal and paternal ages showed significant effects on treatment response (p<0.03) of all paliperidone ER arms versus placebo. Paternal age was significantly correlated to improvement in positive symptoms and maternal age significantly related to negative symptoms, although only paternal age remained significantly associated with the treatment response in analyses that included both parents' ages. CONCLUSIONS: APA was associated with greater treatment response to both paliperidone ER and placebo, but not to age of onset or initial symptom severity in adolescents with schizophrenia. The results support the contention that APA-related schizophrenia has distinct underpinnings from other cases. Further studies are required to explore the role of genetic and environmental factors, and their interactions, in treatment response in this complex disorder.

In this pilot study, amygdala connectivity related to trauma symptoms was explored using resting-state functional magnetic resonance imaging (R-fMRI) in 23 healthy adolescents ages 13-17 years with no psychiatric diagnoses. Adolescents completed a self-report trauma symptom checklist and a R-fMRI scan. We examined the relationship of trauma symptoms to resting-state functional connectivity of the amygdala. Increasing self-report of trauma symptoms by adolescents was associated with increasing functional connectivity with the right amygdala and a local limbic cluster and decreasing functional connectivity with the amygdala and a long-range frontoparietal cluster to the left amygdala, which can be a hallmark of immaturity. These pilot findings in adolescents provide preliminary evidence that even mild trauma symptoms can be linked to the configuration of brain networks associated with the amygdala.

Greater knowledge of cortical brain regions in reward processing may set the stage for using transcranial magnetic stimulation (TMS) as a treatment in patients with avolition, apathy or other drive-related symptoms. This study examined the effects of single pulse (sp) TMS to two reward circuit targets on drive in healthy subjects. Fifteen healthy subjects performed the monetary incentive delay task (MID) while receiving fMRI-guided spTMS to either inferior parietal lobe (IPL) or supplemental motor area (SMA). The study demonstrated decreasing reaction times (RT) for increasing reward. It also showed significant differences in RT modulation for TMS pulses to the IPL versus the SMA. TMS pulses during the delay period produced significantly more RT slowing when targeting the IPL than those to the SMA. This RT slowing carried over into subsequent trials without TMS stimulation, with significantly slower RTs in sessions that had targeted the IPL compared to those targeting SMA. The results of this study suggest that both SMA and IPL are involved in reward processing, with opposite effects on RT in response to TMS stimulation. TMS to these target cortical regions may be useful in modulating reward circuit deficits in psychiatric populations.

This two-part study describes the development and validation of a method for quantifying adolescent personality pathology using the latest edition of the Shedler-Westen Assessment Procedure for Adolescents (SWAP-II-A), an instrument designed to be used by clinically experienced observers. In Study 1, experienced psychologists and psychiatrists described a normative clinical sample of 950 North American patients. Study 2 applied the SWAP-II-A in a day treatment setting. Results indicated that SWAP-II-A personality disorder (PD) scales evidenced high internal consistency, construct validity with Diagnostic and Statistical Manual of Mental Disorders (5th ed.) symptoms and diagnoses, and concurrent validity with Child Behavior Checklist (CBCL) ratings. Independent observers saw patients similarly, and PD assessments were significantly associated with CBCL scale scores and ward behavior. C1 [DeFife, Jared A.] Emory Univ, Sch Med, Dept Psychiat & Behav Sci, Atlanta, GA 30322 USA. [Malone, Johanna C.] Harvard Univ, Sch Med, Massachusetts Gen Hosp, Dept Psychiat, Cambridge, MA 02138 USA. [DiLallo, John] NYU, Sch Med, New York City Adm Childrens Serv, New York, NY 10003 USA. [Westen, Drew] Emory Univ, Dept Psychol, Atlanta, GA 30322 USA. [Westen, Drew] Emory Univ, Dept Psychiat, Atlanta, GA 30322 USA

OBJECTIVE: We sought to establish prevalence rates and detail patterns of comorbidity for generalized anxiety disorder, separation anxiety disorder, and social phobia in preschool-aged children. METHOD: The Duke Preschool Anxiety Study, a screen-stratified, cross-sectional study, drew from pediatric primary care and oversampled for children at risk for anxiety. A total of 917 parents of preschool children (aged 2-5 years) completed the Preschool Age Psychiatric Assessment. RESULTS: Generalized anxiety disorder, separation anxiety disorder, and social phobia are common in preschool-aged children attending pediatric primary care. Three-fourths of preschoolers with an anxiety disorder only had a single anxiety disorder. Generalized anxiety disorder displayed the greatest degree of comorbidity: with separation anxiety disorder (odds ratio [OR] = 4.1, 95% CI = 2.0-8.5), social phobia (OR = 6.4, 95% CI = 3.1-13.4), disruptive behavior disorders (OR = 5.1, 95% CI = 1.6-15.8), and depression (OR = 3.7, 95% CI = 1.1-12.4). CONCLUSIONS: The weakness of association between generalized anxiety disorder and depression stands in contrast to substantial associations between these 2 disorders reported in older individuals. Attenuated associations in preschool-aged children could translate into clinical opportunities for targeted early interventions, aimed at modifying the developmental trajectory of anxiety disorders.

Effective navigation of the social world relies on the correct interpretation of facial emotions. This may be particularly important in formative years. Critically, literature examining the emergence of face processing in youth (children and adolescents) has focused on the neural and behavioral correlates of processing adult faces, which are relationally different from youth participants, and whose facial expressions may convey different meaning than faces of their peers. During a functional magnetic resonance imaging (fMRI) scan, we compared concurrent neural and behavioral responses as youth (N=25) viewed validated, emotionally varied (i.e., anger, fear, happy, and neutral) adult and child face stimuli. We observed that participants made fewer errors when matching adult, compared to child, face stimuli, and that while similar brain regions were involved in processing both adult and child faces, activation in the face processing neural network was greater for adult than child faces. This was true across emotions, and also when comparing neutral adult versus neutral child faces. Additionally, a valence by stimuli-type effect was observed within the amygdala. That is, within adult face stimuli, negative and neutral face stimuli elicited the largest effects, whereas within child face stimuli, happy face stimuli elicited the largest amygdala effects. Thus, heightened engagement of the amygdala was observed for happy child and angry adult faces, which may reflect age-specific salience of select emotions in early life. This study provides evidence that the relational age of the perceived face influences neural processing in youth.