Faculty Bibliography

This trial compared a brief group cognitive-behavioral (CBT) depression prevention program to a waitlist control condition and four placebo or alternative interventions. High-risk adolescents with elevated depressive symptoms (N=225, M age=18, 70% female) were randomized to CBT, supportive-expressive group intervention, bibliotherapy, expressive writing, journaling, or waitlist conditions and completed assessments at baseline, termination, and 1- and 6-month follow-up. All five active interventions showed significantly greater reductions in depressive symptoms at termination than waitlist controls; effects for CBT and bibliotherapy persisted into follow-up. CBT, supportive-expressive, and bibliotherapy participants also showed significantly greater decreases in depressive symptoms than expressive writing and journaling participants at certain follow-up points. Findings suggest there may be multiple ways to reduce depressive symptoms in high-risk adolescents, although expectancies, demand characteristics, and attention may have contributed to the observed effects.

The author notes, from his perspective as a resident reading about prevention research in psychiatry, his first question is whether it can be applied in practice. Many, if not most, authors of research papers about prevention in psychiatry and medicine more generally are public health professionals. That is, they often are situated in departments that focus on research, policy, education, or health care economics. They often are looking at the big picture, suggesting ways to impact the macrocosm of health care services to benefit the microcosm of a person's life. The author feels that all psychiatrists and, in particular residents, can benefit from a preventive perspective. Information about the social epidemiology of psychiatric illnesses and non-clinical interventions that are effective in preventing or ameliorating psychiatric morbidity can contribute greatly to the ideas of cause and effect in psychiatry.

Disease prevention and health promotion are important elements of public health. Psychiatrists may ask what constitutes disease prevention and health promotion in the mental health field and how prevention and promotion fit into their clinical work. Within psychiatry, incorporating a preventive approach--considering risk and protective factors, epidemiology, population-based findings, evidence-based preventive interventions, health promotion, and cost-effectiveness--can be called "prevention psychiatry." Although prevention and promotion often are seen to be within the domain of public health and population-based principles, clinical psychiatrists, whose main focus is treatment, can broaden their approach by addressing: (1) prevention of comorbidities, including the co-occurrence of mental disorders and substance abuse, or mental disorders and physical illnesses (some of which may be induced by psychotropic medications, such as the metabolic syndrome), (2) prevention and promotion activities targeting family members of patients with mental illnesses, and (3) the prevention of suicide.

The relationship between depressive symptoms in young adults, the quality of the early home environment, and early educational child care was investigated in young adults randomly assigned to receive early childhood intervention in the Abecedarian study. Of the original 111 infants enrolled (98% African American), 104 participated in an age-21 follow-up. Those who had early treatment reported fewer depressive symptoms. The protective effects of the early childhood program were further supported by a significant home environment by treatment interaction. Negative effects of lower quality home environments on young adult depressive symptoms were almost entirely offset by preschool treatment, whereas depressive symptoms increased as the quality of the early home environment decreased for those in the control group.

OBJECTIVE: Pediatricians are in a good position to identify women who struggle with depression, but studies show low rates of pediatrician identification and management. It is likely that pediatricians' management of maternal depression may vary on the basis of their attitudes, but no instrument has been developed to measure these attitudes. We sought to develop a measure of pediatricians' attitudes about managing maternal depression and to identify characteristics associated with pediatricians' attitudes about managing maternal depression. METHODS: We conducted a cross-sectional analysis of data provided by 651 practicing, nontrainee pediatricians (response rate 57.5%) surveyed through an American Academy of Pediatrics 2004 Periodic Survey. An exploratory principal components analysis was used to investigate the interrelationships among the attitudinal items. Multivariable linear regression was used to assess the adjusted associations between physician and practice characteristics and attitudes. RESULTS: The attitudinal measure consisted of 3 subscales: acknowledging maternal depression, perceptions of mothers' beliefs, and treating maternal depression. Clinical approaches (eg, interest in further education on identifying or treating maternal depression) and training and work characteristics were significantly related to pediatricians' attitudes; patient characteristics (eg, type of insurance and ethnicity/race) were not significantly associated with pediatricians' attitudes. CONCLUSIONS: We developed a measure to assess pediatricians' attitudes about managing maternal depression. The findings from this study can be used to develop and assess interventions that improve pediatricians' attitudes about acknowledging maternal depression, perceptions of mothers' beliefs, and treating maternal depression.

BACKGROUND: Developmental changes in cognitive and affective processes contribute to adolescent risk-taking behavior, emotional intensification, and psychopathology. The current study examined adolescent development of cognitive control processes and their modulation by incentive, in health and psychopathology. Predictions include 1) better cognitive control in adults than adolescents, and in healthy adolescents than anxious and depressed adolescents, and 2) a stronger influence of incentives in adolescents than adults, and in healthy adolescents than their depressed and anxious counterparts. METHODS: Antisaccadic eye movement parameters, which provide a measure of cognitive control, were collected during a reward antisaccade task that included parameterized incentive levels. Participants were 20 healthy adults, 30 healthy adolescents, 16 adolescents with an anxiety disorder, and 11 adolescents with major depression. Performance accuracy and saccade latency were analyzed to test both developmental and psychopathology hypotheses. RESULTS: Development and psychopathology group differences in cognitive control were found. Specifically, adults performed better than healthy adolescents, and healthy adolescents than anxious and depressed adolescents. Incentive improved accuracy for all groups; however, incremental increases were not sufficiently large to further modulate performance. Incentives also affected saccade latencies, pushing healthy adolescent latencies to adult levels, while being less effective in adolescents with depression or anxiety. This latter effect was partially mediated by anxiety symptom severity. CONCLUSIONS: Current findings evidence the modulation of cognitive control processes by incentives. While seen in both healthy adults and healthy adolescents, this modulatory effect was stronger in youth. While anxious and depressed adolescents exhibited improved cognitive control under incentives, this effect was smaller than that in healthy adolescents. These findings suggest differential incentive and/or cognitive control processing in anxiety and depression, and across development. Differences could result from disorder specific, or combined developmental and pathological mechanisms.

OBJECTIVE: The authors summarize two special sessions focused on the teaching of psychopharmacology at the 2003 and 2004 annual meeting of the American College of Neuropsychopharmacology (ACNP). The focus was on whether "improving the teaching-learning process" in psychiatric residency programs could improve clinical practice. METHOD: Problems of strategies and pedagogic techniques that have been used were presented from multiple perspectives (e.g., from a dean, department chair, training director, and former students). CONCLUSIONS: There was a consensus that action involving psychopharmacology organizations and the American Association of Directors of Residency Training in Psychiatry (AADPRT) was necessary to improve "evidence-based" competencies before graduation and to follow prescribing patterns into clinical practice to determine whether the standards of care could be improved.

OBJECTIVE: Attention-deficit hyperactivity disorder (ADHD) coexisting with epilepsy is poorly understood; thus, we compared the clinical correlates and psychiatric comorbid conditions of 36 children with epilepsy and ADHD aged 6 to 17 years enrolled in an ADHD treatment trial, with those reported in the literature on children with ADHD without epilepsy. METHODS: Measures included the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children (KSADS), the Wechsler Abbreviated Scale of Intelligence (WASI), and the Scales for Independent Behavior-Revised (SIB-R). RESULTS: Mean IQ was 86+/-19, and SIB-R Standard Score was 72+/-26. The ADHD-Combined subtype, composed of both inattentive and hyperactive symptoms, was most frequent (58%). Sixty-one percent exhibited a comorbid disorder, including anxiety disorders (36%) and oppositional defiant disorder (31%). CONCLUSIONS: Comorbidity in ADHD with epilepsy is similar to that in ADHD without epilepsy reported in the literature. These preliminary data argue that the pathophysiology of ADHD has common components in both populations.

The Jerusalem Perinatal Study recorded information on population-based cohorts of 92 408 live- and stillbirths in 1964-76, and their parents, with active surveillance of infant deaths and birth defects. Data on maternal conditions, obstetric complications and interventions during labour and delivery were recorded for 92% of the births. Subsets were surveyed with antenatal interviews in 1965-68 (n = 11 467), paediatric admissions to hospital (n = 17 782) and postpartum interviews in 1975-76 (n = 16 912). Data from some offspring were linked to records of a health examination at age 17. The offspring, mothers and fathers have been traced recently, their vital status assessed, and the data linked to Israel's Cancer Registry and Psychiatric Registry. This paper describes the different types of data available, their sources, and some potential biases. Characteristics of this unique population are shown. Findings from the study are reviewed and a list of references is provided. The cohorts provide a unique source of data for a wide variety of studies