Faculty Bibliography

A transformational process from latency to adolescence is tracked in this essay of a disturbed boy who required an innovative therapeutic action that did not rely on the standard technique of interpretation of defense and conflict. The de-stabilization of the patient's mind-set as a victim was leveraged by the analyst's taking an extreme stance in keeping her own reflections to herself and, instead, assisting the boy's capacity to experience himself as an agent in his own right as he took us both on his journey towards self-discovery. This technical strategy also facilitated the shoring up of fragile self and object boundaries, provided a necessary fillip in the boy's capacity for affect differentiation and integration, and helped to create linkages between self and object representations in the present with hoped-for images of self and other in the future

Introduction: The importance of psychiatric screening of volunteers participating in research on mental illness is well established. Although psychiatric research frequently relies on subjects presumed to be free of medical conditions that affect nervous system function or safety of participants, little information exists on the value of medical screening in this population. This study describes findings on medical evaluations that potentially impact psychiatric research. Methods: The authors conducted a retrospective analysis of medical evaluations in 476 consecutively referred healthy controls and 64 anxiety patients to determine the prevalence of conditions that resulted in exclusion from studies. All subjects had history and physical examination by a board-certified family physician and 37% of participants completed laboratory assessment. Results: One-hundred ten (20%) volunteers were excluded. Exclusion rates were similar for controls and patients. The most common reasons for exclusion were psychiatric conditions (6.3%), positive toxicology screen (5.4%), abnormal liver function tests (4.5%), cardiovascular abnormalities (3.9%), positive viral markers including hepatitis C, hepatitis B, and human immunodeficiency virus (3.5%), anemia (2.5%), neurologic disorders (1.6%), and electrolyte abnormalities (1.0%). Discussion: Medical screening identifies a relatively high rate of conditions in both healthy controls and anxiety patients that could impact on psychiatric research. A significant proportion of exclusions was found on physical exam, laboratory assessment, and toxicology screen. Conclusion: These findings demonstrate the complementary nature of medical and psychiatric evaluations and underscore the need to develop further standards in medical screening procedures of volunteers in psychiatric research.

The adverse impact obesity can have on a person's medical and mental health is overwhelming. As the prevalence and severity of childhood obesity and its related comorbidities continue to swell, there are inadequate effective, long-term solutions for the nonsurgical management of morbidly obese youth. Although they are still controversial, refined surgical procedures have improved the safety and efficacy of bariatric surgery. It is being increasingly used with morbidly obese adolescents under the care of a multidisciplinary treatment team. Bariatric surgery typically results in marked weight loss and the resolution or reduction of comorbid conditions. At a more normalized weight, these adolescents often experience substantial life changes in areas that have the potential to positively, and sometimes negatively alter a person's quality of life. It is important to understand these complex changes in order to facilitate the adolescent's positive long-term outcome. Despite their importance, there are limited empirical studies pertaining to adolescent psychosocial outcomes. Current results support the benefits of bariatric surgery in this population, but more rigorous research studies with prospective data collection and long-term follow up are necessary before pediatric bariatric surgery can be officially sanctioned for this special needs population.

BACKGROUND: A substantial proportion of children with attention-deficit/hyperactivity disorder (ADHD) show deficits on inhibitory control tests. However, questions remain about (i) the extent of these deficits across different inhibitory domains, (ii) their relationship to deficits in non-executive processes and (iii) whether they extend into adolescence. METHODS: Seventy-seven children and adolescents with ADHD and 50 non-ADHD controls completed three inhibitory tasks, a simple two choice RT task (2CR) and an IQ assessment. RESULTS: ADHD was moderately associated with deficits on all tasks (effect sizes d=0.5-0.9). Deficits were equally marked in childhood and adolescence. Inhibitory deficits were not associated with IQ and, although reduced substantially, remained significant after performance on a simple reaction time task was controlled for statistically. DISCUSSION: In highlighting the significant, but limited, role of inhibitory deficits in ADHD, these results are consistent with recent accounts that emphasize the neuropsychological heterogeneity of this condition