Faculty Bibliography

AIM: Family burden is prevalent in psychotic disorders, but little is known about burden experienced by families of patients in early illness. In this exploratory study, we examined the extent of burden reported by families of patients during a putative prodromal period and in the after-math of psychosis onset. METHODS: Family burden was assessed in 23 family members of patients with emerging or early psychosis. The Family Experiences Interview Schedule was used to assess both objective and subjective burden. Objective burden is comprised of increased resource demands and disruption of routine. Subjective burden includes worry, anger/displeasure and resentment at objective burden. RESULTS: Family burden was comparable for the clinical high-risk and recent-onset psychosis patients. Worry was as high as previously reported for more chronic patients. By contrast, there was a relative absence of displeasure/anger. Family members endorsed assisting patients in activities of daily living, although not 'minding' doing so, and reported little need to supervise or control patients' behaviour. CONCLUSIONS: Early in emerging psychotic illness, families report helping patients and worrying about them, but their lives are not yet disrupted and they do not have much anger or resentment. This may be an ideal time then for intervention with families, as worry may motivate help-seeking by families

Nativist and constructivist approaches to the study of development share a common emphasis on characterizing beginning and end states in development. This focus has highlighted the question of preservation and transformation-whether core aspects of the adult end state are present in the earliest manifestations during infancy. In contrast, a developmental systems approach emphasizes the process of developmental change. This perspective eschews the notions of objective starting and ending points in a developmental progression and rejects the idea that any particular factor should enjoy a privileged status in explaining developmental change. Using examples from motor development and animal behavior, we show how a developmental systems framework can avoid the pitfalls of the long and contentious debate about continuity versus qualitative change.

The authors examined the effects of locomotor experience on infants' perceptual judgments in a potentially risky situation--descending steep and shallow slopes--while manipulating social incentives to determine where perceptual judgments are most malleable. Twelve-month-old experienced crawlers and novice walkers were tested on an adjustable sloping walkway as their mothers encouraged and discouraged descent. A psychophysical procedure was used to estimate infants' ability to crawl/walk down slopes, followed by test trials in which mothers encouraged and discouraged infants to crawl/walk down. Both locomotor experience and social incentives affected perceptual judgments. In the encourage condition, crawlers only attempted safe slopes within their abilities, but walkers repeatedly attempted impossibly risky slopes, replicating previous work. The discourage condition showed where judgments are most malleable. When mothers provided negative social incentives, crawlers occasionally avoided safe slopes, and walkers occasionally avoided the most extreme 50 degrees increment, although they attempted to walk on more than half the trials. Findings indicate that both locomotor experience and social incentives play key roles in adaptive responding, but the benefits are specific to the posture that infants use for balance and locomotion.

CONTEXT: Amygdala and ventrolateral prefrontal cortex (vlPFC) dysfunction manifests in adolescents with anxiety disorders when they view negatively valenced stimuli in threatening contexts. Such fear-circuitry dysfunction may also manifest when anticipated social evaluation leads socially anxious adolescents to misperceive peers as threatening. OBJECTIVE: To determine whether photographs of negatively evaluated smiling peers viewed during anticipated social evaluation engage the amygdala and vlPFC differentially in adolescents with and without social anxiety. DESIGN: Case-control study. SETTING: Government clinical research institute. PARTICIPANTS: Fourteen adolescents with anxiety disorders associated with marked concerns of social evaluation and 14 adolescents without a psychiatric diagnosis matched on sex, age, intelligence quotient, and socioeconomic status. MAIN OUTCOME MEASURES: Blood oxygenation level-dependent signal measured with event-related functional magnetic resonance imaging. Before and during neuroimaging scans, participants anticipating social evaluation completed peer- and self-appraisals. Event-related analyses were tailored to participants' ratings of specific peers. RESULTS: Participants classified 40 pictures of same-age peers as ones with whom they did or did not want to engage in a social interaction. Anxious adolescents showed greater amygdala activation than healthy adolescents when anticipating evaluation from peers previously rated as undesired for an interaction. Psychophysiological interaction connectivity analyses also revealed a significant positive association between amygdala and vlPFC activation in anxious vs healthy adolescents in response to these stimuli. CONCLUSIONS: Anticipating social evaluation from negatively perceived peers modulates amygdala and vlPFC engagement differentially in anxious and healthy adolescents. Amygdala and vlPFC dysfunction manifests in adolescent anxiety disorders in specific contexts of anticipated peer evaluation.

Memory consolidation during sleep is regaining attention due to a wave of recent reports of memory improvements after sleep or deficits after sleep disturbance. Neuromodulators have been proposed as possible players in this putative off-line memory processing, without much experimental evidence. We recorded neuronal activity in the rat noradrenergic nucleus locus coeruleus (LC) using chronically implanted movable microelectrodes while monitoring the behavioral state via electrocorticogram and online video recording. Extracellular recordings of physiologically identified noradrenergic neurons of LC were made in freely behaving rats for 3 h before and after olfactory discrimination learning. On subsequent days, if LC recording remained stable, additional learning sessions were made within the olfactory discrimination protocol, including extinction, reversals, learning new odors. Contrary to the long-standing dogma about the quiescence of noradrenergic neurons of LC, we found a transient increase in LC activity in trained rats during slow wave sleep (SWS) 2 h after learning. The discovery of learning-dependent engagement of LC neurons during SWS encourages exploration of brain stem-cortical interaction during this delayed phase of memory consolidation and should bring new insights into mechanisms underlying memory formation

OBJECTIVES: We intend to review the importance of appropriately recognizing and managing attention deficit/attention deficit hyperactivity disorder (ADD/ADHD) in the acute psychiatric hospital setting. METHODS: We demonstrate the management of three patients with associated ADD/ADHD diagnosis in the hospital setting. This case series is followed by a review of the literature on the treatment of ADD/ADHD with particular focus on inpatient treatment. RESULTS: Given that the core symptoms of ADD/ADHD are inattention, hyperactivity, poor concentration, impulsivity, poor organization and emotional instability, it follows that a comprehensive inpatient treatment plan should address these issues in order to obtain sustained, focused participation on the part of the patient. Suppression of ADD/ADHD symptoms with stimulants greatly enhanced our patients' ability to more productively and actively participate in the treatment of the acute psychiatric problems which led to their admission. CONCLUSIONS: Currently, no published data exist on prevalence of ADD/ADHD in psychiatric hospitals, rates of treatment and outcome of treatment with regard to recovery and quality of aftercare. Nonetheless, the benefits of treating ADD/ADHD among psychiatric inpatients may be seen in case examples and are also apparent in the data concerning treatment of ADD/ADHD in the dually diagnosed

Autism is currently viewed as a spectrum condition that includes strikingly different severity levels; IQ is consistently described as one of the primary aspects of the heterogeneity in autism. To investigate the possibility of more than one distinct subtype of autism based on IQ both latent class analysis and taxometrics methods were used to classify Mullen IQs in a sample of 456 children with autism spectrum disorder. We found evidence for multiple IQbased subgroups using both methods. Groups differed in level of intellectual functioning and patterns of verbal versus nonverbal ability. Results support the notion of distinct subtypes of autism that differ in severity of intellectual ability, patterns of cognitive strengths and weaknesses, and severity of autism symptoms