Faculty Bibliography

OBJECTIVE: To identify the predictors of suicidal events and attempts in adolescent suicide attempters with depression treated in an open treatment trial. METHOD: Adolescents who had made a recent suicide attempt and had unipolar depression (n =124) were either randomized (n = 22) or given a choice (n = 102) among three conditions. Two participants withdrew before treatment assignment. The remaining 124 youths received a specialized psychotherapy for suicide attempting adolescents (n = 17), a medication algorithm (n = 14), or the combination (n = 93). The participants were followed up 6 months after intake with respect to rate, timing, and predictors of a suicidal event (attempt or acute suicidal ideation necessitating emergency referral). RESULTS: The morbid risks of suicidal events and attempts on 6-month follow-up were 0.19 and 0.12, respectively, with a median time to event of 44 days. Higher self-rated depression, suicidal ideation, family income, greater number of previous suicide attempts, lower maximum lethality of previous attempt, history of sexual abuse, and lower family cohesion predicted the occurrence, and earlier time to event, with similar findings for the outcome of attempts. A slower decline in suicidal ideation was associated with the occurrence of a suicidal event. CONCLUSIONS: In this open trial, the 6-month morbid risks for suicidal events and for reattempts were lower than those in other comparable samples, suggesting that this intervention should be studied further. Important treatment targets include suicidal ideation, family cohesion, and sequelae of previous abuse. Because 40% of events occurred with 4 weeks of intake, an emphasis on safety planning and increased therapeutic contact early in treatment may be warranted.

Childhood parasomnias and movement disorders arise from a variety of etiologic factors. For some children, psychopathology plays a causal role in sleep disorders; in other cases, recurrent parasomnia episodes induce psychopathology. Current research reveals complex interconnections between sleep and mental health. As such, it is important that clinicians consider the impact psychiatric disorders have on childhood parasomnias. This article describes common parasomnias and movement disorders in children and adolescents, with emphasis on psychologic and behavioral comorbidities

Exposure to multiple traumas, particularly in childhood, has been proposed to result in a complex of symptoms that includes posttraumatic stress disorder (PTSD) as well as a constrained, but variable group of symptoms that highlight self-regulatory disturbances. The relationship between accumulated exposure to different types of traumatic events and total number of different types of symptoms (symptom complexity) was assessed in an adult clinical sample (N = 582) and a child clinical sample (N = 152). Childhood cumulative trauma but not adulthood trauma predicted increasing symptom complexity in adults. Cumulative trauma predicted increasing symptom complexity in the child sample. Results suggest that Complex PTSD symptoms occur in both adult and child samples in a principled, rule-governed way and that childhood experiences significantly influenced adult symptoms

Adaptive social skills were assessed longitudinally at approximately ages 2, 3, 5, 9, and 13 years in a sample of 192 children with a clinical diagnosis of autism (n = 93), PDD-NOS (n = 51), or nonspectrum developmental disabilities (n = 46) at age 2. Growth curve analyses with SAS proc mixed were used to analyze social trajectories over time. Both individual characteristics and environmental resources emerged as key predictors of adaptive social behavior outcome. The gap between children with autism and the other two diagnostic groups widened with time as the social skills of the latter groups improved at a higher rate. However, within diagnostic groups, improvement ranged from minimal to very dramatic. Children with autism most at risk for problems with social adaptive abilities later in life can be identified with considerable accuracy at a very young age so they can be targeted for appropriate early intervention services

BACKGROUND: Previous theories implicate hippocampal dysfunction in anxiety disorders. Most of the data supporting these theories stem from animal research, particularly lesion studies. The generalization of findings from rodent models to human function is hampered by fundamental inter-species differences. The present work uses a task of spatial orientation, which is known to rely on hippocampal function. Deficits in spatial navigation in anxious children suggest that the hippocampal network involved in spatial orientation is also implicated in anxiety disorders. METHODS: Thirty-four treatment-naive children with an anxiety disorder (mean 11.00 years +/- 2.54) are compared to 35 healthy age- and IQ-matched healthy children (mean 11.95 years +/- 2.36) on a virtual, computer-based equivalent of the Morris Water Maze task. RESULTS: Results indicate that children with anxiety disorder exhibit overall impaired performance relative to the comparison group. Anxious children made more heading direction errors and had worse accuracy in completing trials relative to controls. CONCLUSIONS: The results present novel evidence that spatial orientation deficits occur in pediatric anxiety.

OBJECTIVE: Numerous studies have implicated the hippocampus and prefrontal cortex in schizophrenia. However, precisely which subregions of the hippocampus and prefrontal cortex are abnormal remain unknown. Our study goal was to investigate the structure of the anterior hippocampus, posterior hippocampus, dorsolateral prefrontal cortex (DLPFC), and orbitofrontal cortex (OFC) simultaneously in thirty-eight patients with schizophrenia and twenty-nine controls to determine which of these subregions are abnormal in schizophrenia. As an exploratory study goal, we investigated the relation of neurocognition to brain structure in schizophrenia patients. METHOD: We generated detailed structural magnetic resonance imaging data and compared hippocampal and prefrontal subregional structural brain volumes between schizophrenia and control groups. We obtained a neurocognitive test battery in schizophrenia patients and studied the association of abnormal brain structures to neurocognition. RESULTS: Structural brain abnormalities were pinpointed to the left anterior hippocampus and left OFC in schizophrenia patients, which were both significantly reduced in volume. The DLPFC and posterior hippocampus, though numerically decreased in volume, were not significantly decreased. Anterior hippocampal volumes were more strongly associated with OFC volumes in schizophrenia patients compared to controls. By contrast, DLPFC volume was unrelated to anterior or posterior hippocampal volume. Both the anterior hippocampus and OFC were independently related to cognitive abnormalities common in schizophrenia, including indices of verbal, language, and executive functions. The DLPFC and posterior hippocampal volumes were unrelated to cognitive measures. CONCLUSIONS: These findings highlight related abnormalities of the anterior hippocampus and OFC in schizophrenia, which may shed light on the pathophysiology of the disorder

OBJECTIVE: This phenomenological research study reports preliminary findings about experiences of persons undergoing repeated transcranial magnetic stimulation (rTMS) for depression treatment. METHODS: Giorgi's phenomenology was the method used to describe the structure of the lived experience for persons having undergone rTMS treatment for depression. Participants were recruited from the OPT-TMS pivotal depression study that resulted in the October 2008 FDA approval of rTMS. Thus far, nine persons comprise the purposive sample. Each participant was asked to describe the experience of undergoing rTMS for depression treatment and encouraged to provide as much details as possible. RESULTS: Four preliminary themes emerged to describe participants' experiences of rTMS for depression treatment: (a) a narrative of frustration and helplessness with medication treatment resistance, (b) the sensory experience of rTMS, (c) mindfulness- an enhanced awareness of the content of consciousness, and (d) the importance of connection with clinicians. CONCLUSIONS: Preliminary results of this phenomenological study make the struggle of persons with treatment-resistant depression more visible and should assist clinicians to understand how rTMS is experienced by depressed persons undergoing treatment. Moreover, results shed new light on the changes participants observe and describe with rTMS and the high value they place on a therapeutic relationship with clinicians administering treatment.

PURPOSE: To illustrate time trends and trajectories of bullying and identify demographic predictors of bullying. METHODS: A prospective study of 1666 seventh- and eighth-grade students from two Korean middle schools was conducted between 2000 and 2001. Using the Korean-Peer Nomination Inventory, bullying was categorized into four groups: victim, perpetrator, victim-perpetrator, and neither. RESULTS: Only the prevalence of male victims significantly decreased over the course of the study. Most students uninvolved in bullying at baseline remained so over the study period. In all, 52-58% of baseline victims and perpetrators and 74% of victim-perpetrators continued to be involved in bullying. Significantly more boys were involved with bullying than girls; individual stability of bullying behavior did not differ by gender. Shorter, heavier boys and those from lower SES, whose fathers had lower educational levels or whose mothers had higher educational levels, as well as shorter girls from Seoul or non-intact families, were at an increased risk for bullying. CONCLUSIONS: Except for a modest decline in the number of male victims, participation in bullying (especially by victim-perpetrators) is stable over time. Along with disadvantaged background, distinct demographic profiles of bullying involvement by sex and bullying groups emerged, allowing early identification of bullying and targeting intervention and prevention