Faculty Bibliography

OBJECTIVE: An important question in pediatric bipolar research is whether marked nonepisodic irritability is a manifestation of bipolar disorder in youth. This study tests the hypothesis that youth with severe mood dysregulation (SMD), a category created for the purpose of studying children presenting with severe nonepisodic irritability, will be significantly less likely to develop (hypo-)manic or mixed episodes over time than will youth with bipolar disorder (BD). METHOD: Patients with SMD (N = 84) and narrowly defined BD (N = 93) at baseline were followed up in 6-monthly intervals using the relevant K-SADS modules to ascertain (hypo-)manic or mixed episodes. RESULTS: Only one of 84 SMD subjects (1/84 [1.2%]; 95% confidence interval CI = 0.0003 to 0.064) experienced a (hypo-)manic or mixed episode during the study (median follow-up = 28.7 months). The frequency of such episodes was more than 50 times higher in those with narrowly defined BD (58/93 [62.4%]; 95% CI 0.52 to 0.72). CONCLUSIONS: These data suggest that, over an approximately 2-year follow-up period, youth with SMD are unlikely to develop (hypo-)manic or mixed episodes.

Nucleic acid testing (NAT) for HIV, HBV and HCV shortens the time between infection and detection by available testing. A group of experts was selected to develop recommendations for the use of NAT in the HIV/HBV/HCV screening of potential organ donors. The rapid turnaround times needed for donor testing and the risk of death while awaiting transplantation make organ donor screening different from screening blood-or tissue donors. In donors with no identified risk factors, there is insufficient evidence to recommend routine NAT, as the benefits of NAT may not outweigh the disadvantages of NAT especially when false-positive results can lead to loss of donor organs. For donors with identified behavioral risk factors, NAT should be considered to reduce the risk of transmission and increase organ utilization. Informed consent balancing the risks of donor-derived infection against the risk of remaining on the waiting list should be obtained at the time of candidate listing and again at the time of organ offer. In conclusion, there is insufficient evidence to recommend universal prospective screening of organ donors for HIV, HCV and HBV using current NAT platforms. Further study of viral screening modalities may reduce disease transmission risk without excessive donor loss.

In reading the work of Beebe (2002), Sander (Amadei & Bianchi 2008), Tronick (2007) and Stern and the Boston Change Process Study Group (1998), resonances to the transcendent function can be registered but these researchers seem to be more focused on the interpersonal domain. In particular Tronick's concept of 'dyadic expansion of consciousness' and 'moments of meeting' from the Boston Change Process Study Group describe external dyadic interactions between mothers and babies and therapists and patients while, in contrast, Jung's early focus was on the intrapsychic process of internal interaction between conscious and unconscious within an individual. From an overall perspective, the interpersonal process of change described by infant researchers, when held in conjunction with Jung's internal process of change, together form a transcendent whole that could also be called a complex adaptive system. Such new theoretical perspectives from other fields confirm and elaborate long held Jungian notions such as the transcendent function which is, in many ways, harmonious with a systems perspective. Throughout this paper, clinical vignettes of interactive moments along with sand play and dreams will be used to illustrate theoretical points regarding the healthy process of the transcendent function along with descriptions of failures of such conjunctive experiences

Cerebral palsy (CP) is a disorder of motor and posture impairment resulting from brain injury prior to completion of cerebral development. It affects 2 to 3 per 1000 individuals. CP is also associated with sensory, behavioral, cognitive, and emotional sequelae. Few systematic studies of psychiatric comorbidities in children and adolescents with CP have been conducted, as the main focus of concern has been on the physical disabilities. This has diverted attention from treatable psychiatric syndromes. Proper psychiatric evaluation of children with CP is an important task, as appropriate interventions can help them reach their full potential and enhance the quality of their lives and those of their families. We report the case of an individual with CP with behavioral and emotional symptoms to illustrate the diagnostic complexity involved. The case highlights the importance of engaging in a comprehensive diagnostic psychiatric evaluation process to assess and suggest treatment options for accompanying comorbid psychiatric conditions

One goal of statistical shape analysis is the discrimination between two populations of objects. Whereas traditional shape analysis was mostly concerned with single objects, analysis of multi-object complexes presents new challenges related to alignment and pose. In this paper, we present a methodology for discriminant analysis of multiple objects represented by sampled medial manifolds. Non-euclidean metrics that describe geodesic distances between sets of sampled representations are used for alignment and discrimination. Our choice of discriminant method is the distance-weighted discriminant because of its generalization ability in high-dimensional, low sample size settings. Using an unbiased, soft discrimination score, we associate a statistical hypothesis test with the discrimination results. We explore the effectiveness of different choices of features as input to the discriminant analysis, using measures like volume, pose, shape, and the combination of pose and shape. Our method is applied to a longitudinal pediatric autism study with 10 subcortical brain structures in a population of 70 subjects. It is shown that the choices of type of global alignment and of intrinsic versus extrinsic shape features, the latter being sensitive to relative pose, are crucial factors for group discrimination and also for explaining the nature of shape change in terms of the application domain.

BACKGROUND: Oxytocin is a neuropeptide that is associated with increased trust. Perceptions of trustworthiness are associated with detection of positive facial affect, which suggests that oxytocin may enhance the recognition of positive facial affect. The present study tests this hypothesis. METHODS: A double-blind, between-groups design was used, with 50 volunteers randomly assigned to receive intranasally administered oxytocin or placebo. Thirty-five minutes following the administration of oxytocin or placebo, participants identified anger, disgust, fear, happiness, sadness, and surprise expressions that were morphed with neutral faces such that they varied from 10% to 100% intensity. RESULTS: Oxytocin significantly and specifically improved the recognition of happy facial expressions; no significant differences in recognition of other expression were found. The improvement was not associated with gender, response biases, or changes in mood, and it was most pronounced for subtle expressions. CONCLUSIONS: Acute oxytocin administration enhances healthy adults' ability to accurately identify positive emotional facial expressions. These findings reinforce oxytocin's role in facilitating affiliative interactions and have implications for the treatment of conditions that are marked by social affiliation deficits.

PURPOSE: This article examines gender differences in attitudes toward sexual risk-taking behaviors of acquired immune deficiency syndrome (AIDS)-orphaned youth participating in a randomized control trial testing an economic empowerment intervention in rural Uganda. METHODS: Adolescents (average age 13.7 years) who had lost one or both parents to AIDS from 15 comparable schools were randomly assigned to either an experimental (n=135) or a control condition (n=142). Adolescents in the experimental condition, in addition to usual care, also received support and incentives to save money toward secondary education. RESULTS: Findings indicate that although adolescent boys and girls within the experimental condition saved comparable amounts, the intervention appears to have benefited girls, in regard to the attitudes toward sexual risk-taking behavior, in a different way and to a lesser extent than boys. CONCLUSIONS: Future research should investigate the possibility that adolescent girls might be able to develop equally large improvements in protective attitudes toward sexual risk taking through additional components that address gendered social norms.