Faculty Bibliography

OBJECTIVE: High smoking rates in adults with attention-deficit/hyperactivity disorder (ADHD) and nicotine's amelioration of ADHD suggest that effective ADHD treatment might facilitate abstinence in smokers with ADHD. The present study evaluated if using osmotic-release oral system methylphenidate (OROS-MPH) to treat ADHD enhances response to smoking cessation treatment in smokers with ADHD. METHOD: A randomized, double-blind, placebo-controlled, 11-week trial with a 1-month follow-up was conducted at 6 clinical sites between December 2005 and January 2008. Adults (aged 18-55 years) meeting DSM-IV criteria for ADHD and interested in quitting smoking were randomly assigned to OROS-MPH titrated to 72 mg/d (n = 127) or placebo (n = 128). All participants received brief weekly individual smoking cessation counseling for 11 weeks and 21 mg/d nicotine patches starting on the smoking quit day (day 27) through study week 11. Outcome measures included prolonged smoking abstinence and DSM-IV ADHD Rating Scale (ADHD-RS) score. RESULTS: Of 255 randomly assigned participants, 204 (80%) completed the trial. Prolonged abstinence rates, 43.3% and 42.2%, for the OROS-MPH and placebo groups, respectively, did not differ significantly (OR = 1.1; 95% CI, 0.63-1.79; P = .81). Relative to placebo, OROS-MPH evidenced a greater reduction in DSM-IV ADHD-RS score (P < .0001) and in cigarettes per day during the post-quit phase (P = .016). Relative to placebo, OROS-MPH increased blood pressure and heart rate to a statistically, but not clinically, significant degree (P < .05); medication discontinuation did not differ significantly between treatments. CONCLUSIONS: Treatment for ADHD did not improve smoking cessation success; OROS-MPH, relative to placebo, effectively treated ADHD and was safe and generally well tolerated in this healthy sample of adult ADHD smokers. TRIAL REGISTRATION: clinical trials.gov Identifier: NCT00253747

The idea of a "bipolar spectrum" is controversial due to 1) lack of widely accepted definitions, 2) concern that spectrum definitions might subsume cases with non-bipolar disorders, 3) worry that "diagnostic creep" may lead practitioners to overdiagnose bipolar disorder in marginal cases, and 4) worry that more diagnosis of bipolar spectrum may increase aggressive pharmacotherapy. These concerns are weighed against theoretical and empiric evidence converging in support of the bipolar spectrum as having prognostic and prescriptive validity. Practitioners can use inexpensive and practical strategies to incorporate the spectrum concept into their work while minimizing risks of overdiagnosis or unnecessary medication exposure.

Background: The prevalence of child and adolescent obesity in the US has more than tripled since 1970 predicting a public health problem of considerable personal and societal costs in the coming decades. The psychological correlates of obesity have received recent attention with data showing decreased volume in orbito-frontal cortex and worsened executive function in obese children and large epidemiologic work showing associations between weight and ADHD as well as depression in youth. Relatively little of this work, however, has been performed in an urban minority population. We examined a population of African American and Latino youth from 2 New York City Public Schools to examine correlations between race, BMI, gender and psychopathology on the Child Behavior Checklist Methods: We evaluated 254 adolescents, 76.1% Hispanic, 16.3% African-American and 6.4% other ethnicity, ages 14 to 20 from 2 New York city public schools. Psychological measures were evaluated with the Child Behavior Checklist/ Youth Self Report. Weight was assessed with a Detecto balance beam scale and height with an accompanying stadiometer. The primary outcome measures were effects on weight and body mass index (BMI) as well as change in subsection score on CBCL. Results: This cohort had an average BMI of 30.1+/-5.6 (range 20.1-49.9). Girls scored higher than boys on self reports of somatic complaints 68.5+/-16.4 vs 63.8+/-14.4 p=, 01, interenalizing symptoms 59.3+/-26.0 vs 53.0+/-26.1 and total problems 61.1+/-25.9 vs 53.4+/-27.9). When looking at the effect of BMI, positive associations were found in boys between BMI and somatic complaints (r=.193, p=.035) and total psychiatric problems (r=.204, p=.026) but not in girls. In addition, only boys were sensitive to the effects of obesity (defined as BMI>30.0) with significant increases in scores of Anxiety/ Depression (62.5+/-16.3 vs 56.7+/-16.7). There were statistically significant gender by BMI interactions for somatic complaints (r=-0.128, p=.04) and total problems (r=-.121, p=.05). Race did not predict CBCL score nor did it interact with gender or BMI to predict CBCL psychopathology scores. Discussion: While measures of psychopathology were higher overall for girls, obesity was a vulnerability factor for boys in our largely overweight primarily Hispanic population. Only boys had significant correlations between increased BMI and higher self report of somatic symptoms and total problems. Obese boys also scored significantly higher on self ratings of anxiety/depression. Research has shown obesity to have clear neurobiological effects as well as social and psychological effects. In our sample weight and obesity was a vulnerability factor for boys but not for girls. Whether this is an effect of obesity interacting with hormonal or cultural factors cannot be interpreted in this cross sectional design, however this study provides preliminary data on the relationship between gender, psychiatric and metabolic dysregulation. Further exploration is needed to determine endocinologic, psychological and sociocultural factors that may underlie these trends as well as longitudinal work to help explain the temporal direction of these correlations

An implementation study of cognitive-behavioral therapies (CBT) was conducted for traumatized youth in a postdisaster context. Headed by the New York State Office of Mental Health, the study targeted youth (N = 306) ages 5-21 affected by the World Trade Center disaster. They received either trauma-specific CBT or brief CBT skills depending upon the severity of trauma symptoms. Clinicians were trained to deliver these interventions and received monthly consultation. A regression discontinuity design was used to assess optimal strategies for matching need to service intensity. At 6-months postbaseline, both groups had improved. Rate of change was similar despite differences in severity of need. The implications for the implementation of evidence-based treatments postdisaster are discussed

Although literature supports the association between harmonious coparenting practices and lowered child problems, little is known about coparenting influences among family constellations in the foster care system. Via a compilation of a new coparenting practices measure, we examined similarities and differences on foster parent-derived perceptions of support/flexibility, shared communication, conflict/triangulation, and total coparenting between foster and biological parents and their independent contribution to child internalizing and externalizing problems. Self-reports were gathered from foster parents (N=80) in 2 groups: kin and nonkin. As compared with nonkin, kin foster parents reported higher perceived support/flexibility, shared communication, and total coparenting. A tendency for higher conflict/triangulation among kin foster parents was also found. After considering foster parent group, psychological distress, and harsh discipline, hierarchical regression analyses revealed that perceived total coparenting and conflict/triangulation contributed to child internalizing and externalizing problems. Results support the linkage between perceptions of coparenting and child problems among caregivers (foster and biological alike) in kin and nonkin arrangements and highlight training in coparenting in general, and conflict management in particular, as an important intervention focus to reduce the high level of child problems in this vulnerable population.

OBJECTIVE: The aim of the Longitudinal Assessment of Manic Symptoms (LAMS) study is to examine differences in psychiatric symptomatology, diagnoses, demographics, functioning, and psychotropic medication exposure in children with elevated symptoms of mania (ESM) compared to youth without ESM. This article describes the initial demographic information, diagnostic and symptom prevalence, and medication exposure for the LAMS cohort that will be followed longitudinally. METHOD: Guardians of consecutively ascertained new outpatients 6 to 12 years of age presenting for treatment at one of 10 university-affiliated mental health centers were asked to complete the Parent General Behavior Inventory-10-Item Mania Scale (PGBI-10M). Patients with scores >/= 12 on the PGBI-10M (ESM+) and a matched sample of patients who screened negative (ESM-) were invited to participate. Patients were enrolled from December 13, 2005, to December 18, 2008. RESULTS: 707 children (621 ESM+, 86 ESM-; mean [SD] age = 9.4 [2.0] years) were evaluated. The ESM+ group, compared to the ESM- group, more frequently met DSM-IV criteria for a mood disorder (P < .001), bipolar spectrum disorders (BPSD; P < .001), and disruptive behavior disorders (P < .01). Furthermore, they showed poorer overall functioning and more severe manic, depressive, attention-deficit/hyperactivity, disruptive behavioral, and anxiety symptoms. Nevertheless, rates of BPSD were relatively low in the ESM+ group (25%), with almost half of these BPSD patients (12.1% of ESM+ patients) meeting DSM-IV criteria for bipolar disorder not otherwise specified. ESM+ children with BPSD had significantly more of the following: current prescriptions for antipsychotics, mood stabilizers, and anticonvulsants (P < .001 for each); psychiatric hospitalizations (P < .001); and biological parents with elevated mood (P = .001 for mothers, P < .013 for fathers). ESM+ children with BPSD were also lower functioning compared to ESM+ children without BPSD. CONCLUSIONS: Although ESM+ was associated with higher rates of BPSD than ESM-, 75% of ESM+ children did not meet criteria for BPSD. Results suggest that longitudinal assessment is needed to examine which factors are associated with diagnostic evolution to BPSD in children with elevated symptoms of mania.

Analytic tools for addressing spontaneous brain activity, as acquired with fMRI during the 'resting-state,' have grown dramatically over the past decade. Along with each new technique, novel hypotheses about the functional organization of the brain are also available to researchers. We review six prominent categories of resting-state fMRI data analysis: seed-based functional connectivity, independent component analysis, clustering, pattern classification, graph theory, and two 'local' methods. In surveying these methods, we address their underlying assumptions, methodologies, and novel applications