Pathways linking affective disturbances and physical disorders.

Comorbidity of psychological and physical disorders is substantial. This article presents a broad theoretical framework for identifying factors that contribute to and maintain comorbid conditions. The authors propose heuristic models of how co-occurrences of psychological and physical disorders are developed and maintained. The models specify biological, behavioral, cognitive, and social pathways that may account for comorbidity. Although the authors' discussion of psychological disorders is limited to the role of affective disturbances (subclinical negative moods as well as mood and affective disorders), the pathways they identify are thought to contribute to co-occurrences of other psychological disorders and physical disease as well. The authors emphasize that pathways linking comorbid states are bi-directional and that operative pathways differ depending on the specific affective response, illness behavior, disease, or disease stage. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diagnostic issues in borderline disorders.

Current theories and psychological test findings on borderline disorders reveal that there are patients whose clinical behaviors are similar to one another; they are afflicted with such symptoms of emotional instability as intense problematic interpersonal relationships, and a tendency to injure themselves or to set up situations in which they are victimized. At best, these patients are difficult to treat. They manifest traits representative of various personality disturbances (see, e.g., American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, 3rd ed.), as well as severe affective disorders. At times, they appear schizophrenic; often, their behavior is neurotic. As they are in transition, they cannot be diagnosed at a given moment in time, except by inference from a longitudinal study of their behavior, and by an analysis of the transference and countertransference that is being experienced. In this author's opinion, many psychological test findings lack reliability and validity and there is no basis for the label borderline disorder as a stable, discrete entity, at least not yet. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Mental illness" or interpersonal behavior?

"There is no such thing as a 'mental illness' in any significantly meaningful sense. The plain fact is that the term 'mental illness' is applied in an indiscriminate way to a motley collection of interpersonal behavior patterns. Mental illness is a phenomenon involving interpersonal behavior, not a health or medical problem. Programs of alleviation and prevention must therefore rest upon a systematic understanding of interpersonal conduct. Suitable psychological terminology is badly needed to clarify numerous vaguely worded, inappropriately phrased and poorly understood questions in psychology today." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nursing and Psychological Treatments.

Presents a comment on "Psychological Treatments" (see record 2004-21168-001) by D. H. Barlow. In his article, Barlow pointed to the need "to solidify the identification of psychology as a health care profession" by changing the terminology of practice in the health care context from psychotherapy to psychological treatments and suggested that the only persons qualified to carry out such interventions are doctoral-level psychologists. Unfortunately, there was no discussion of the health care professionals who already provide psychological treatments in health care settings and their contribution to the evidence base supporting such treatment. The authors find several aspects of the article to be problematic. Overall, the authors feel that suggesting that psychology should claim treatment of psychological disorders and psychological components of physical disorders in health care settings as exclusively its own domain ignores the research and clinical contributions of others. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Sell decision: Implications for psychological assessment and treatment.

This article describes 2 important practice considerations affirmed in the U.S. Supreme Court's Sell v. United States (2002) decision: (a) the importance of providing least restrictive services prior to interventions that violate patients' liberty interests, and (b) contextual and environmental factors may be considered in clinical determinations of dangerousness. The psychological treatment of behavior disorders fall within the purview of least restrictive or intrusive interventions compared with the involuntary administration of psychoactive medications. To legitimately comply with the least restrictive criterion, the provision of psychological services is essential. This long-held criterion is rarely acknowledged today as providers use restricted service arrays and attempt to resolve complex and co-occurring behavior problems with medications and restraints. Less restrictive psychological interventions are required for effective treatment of challenging behaviors. A 2nd significant implication lies in the court's affirmation that it is legitimate to consider contextual factors such as history and current environmental conditions in determining dangerousness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavior therapy: A review.

The questionable effectiveness of traditional psychodynamic psychotherapies and the development of brief new treatment techniques derived from modern learning theory have stimulated interest in applications of conditioning procedures to behavior disorders. A review of this literature revealed that behavior therapies have been applied to many neurotic and psychotic disorders, and have been most successful with disorders involving specific maladaptive behaviors. Conditioning procedures were highly effective with phobic reactions, anxiety reactions, enuresis, stuttering, and tics, but disappointing with alcoholism and some sexual disorders. Cures seemed long-lasting, with remarkably little evidence of the symptom substitution predicted by psychodynamic depth theories. Behavior therapy offers promising opportunities for the application of well-established psychological principles to the treatment of maladaptive behavior. (4 p. ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of the evidence base for treatment of childhood psychopathology: Externalizing disorders.

This article reviews controlled research on treatments for childhood externalizing behavior disorders. The review is organized around 2 subsets of such disorders: disruptive behavior disorders (i.e., conduct disorder, oppositional defiant disorder) and attention-deficit/hyperactivity disorder (ADHD). The review was based on a literature review of nonresidential treatments for youths ages 6-12. The pool of studies for this age group was limited, but results suggest positive outcomes for a variety of interventions (particularly parent training and community-based interventions for disruptive behavior disorders and medication for ADHD). The review also highlights the need for additional research examining effectiveness of treatments for this age range and strategies to enhance the implementation of effective practices. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavior and affect in Alzheimer's disease

The behavioral symptoms associated with AD are a critical aspect of the disease. They provide an additional avenue not only for understanding AD but for implementing interventions. The nature of behavioral disorders in AD is complicated by a number of factors that interact and contribute to the development of problematic behavior. It is difficult to determine whether the behavior is the result of neurodegeneration, cognitive dysfunction, previous experiences, current stressors, independently coexisting psychopathology, or a combination of these factors. In any case, behavioral disturbances need to be more clearly defined and objectively measured. To understand and treat behavioral disturbances in AD, all biopsy-chosocial factors must be examined simultaneously. Currently, there is little that can be done to treat the cognitive components of AD. Consequently, our most successful and beneficial interventions may focus on the remediable behavioral manifestations of the disease. The most valuable treatment approach for patients with AD and their caregivers interweaves medications, psychosocial services, environmental strategies, and caregiver education.     

The role of physical exercise in alcoholism treatment and recovery.

A growing body of literature has demonstrated that physical exercise is associated with favorable mental health outcomes. Exercise has the potential to be an accessible and affordable adjunct treatment option for persons with alcohol use disorders (AUD); however, exercise-based interventions have rarely been applied to this population. The authors examine the potential role of physical exercise in the process of recovery from AUD. Possible physiological, psychological, and social mechanisms whereby exercise may exert influence on alcohol use outcomes are outlined. Studies examining the effects of physical exercise on alcohol and other addictive behaviors are reviewed, and the viability of structured, exercise-based adjunct interventions for AUD populations is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Association of Antisocial Behavior and Depressive Symptoms Between Partners and Risk for Aggression in Romantic Relationships.

This study examined the extent to which antisocial behavior and depressive symptoms were associated between romantic partners and whether the partner's antisocial behavior and depressive symptoms affected the individual's aggression toward the partner above and beyond the contribution of his or her own symptoms. Questions were examined concurrently and longitudinally for 79 couples from a young, at-risk sample. There were reliable associations between partners' antisocial behavior and depressive symptoms. Women's antisocial behavior and depressive symptoms were significantly related to concurrent levels of men's physical and psychological aggression. Women's depressive symptoms remained significant in predicting men's psychological aggression over time. Overall, men's risk factors had little effect on their partners' aggression. Findings suggest that interventions to reduce partner violence need to consider the potential influence of partner, as well as perpetrator characteristics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A validity study of functionally-based behavioral consultation with students with emotional/behavioral disabilities.

Eighteen students (K-11th grade) with emotional/behavioral disorders who were at-risk for change of placement to more restrictive settings participated. Construct validity of functional behavioral assessment (FBA) was assessed with a multifunction-multimethod matrix that showed excellent convergent and divergent agreement with combined FBA methods and functional analysis results. Treatment validity was assessed with random assignment to either a FBA with consultation condition (FBC) or to a behavioral consultation without FBA condition (BC). Growth curve analysis showed a significant decrease in inappropriate behavior from baseline to treatment for both treatment groups compared to a control group. The efficiency of teachers' implementation effected treatment validity. Effect sizes showed that regardless of treatment condition that interventions with good fidelity realized the largest effect (d = -1.14). Social and habilitative validity was assessed with telephone interviews conducted a year after treatment. Sixty-five percent attributed the students' problem behaviors to their thoughts or feelings, whereas only 25% attributed it to classroom variables. Many (57%) indicated the most helpful intervention would be individual counseling, whereas only 14% indicated a more involved classroom management plan would be useful. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Post-transcriptional block in oxytocin gene expression within the seminiferous tubules of the bovine testis

Immunodeficiency is frequently invoked as an ethiopathogenetic factor for many somatic diseases. On the other hand, stress, depression, and psychotic disturbances are associated with severe immunological disorders. Taking into account that the benzodiazepines (BZ) are the psychoactive drugs more widely used than any other to treat psychological disturbances, it seems important to elucidate the immuno-enhancing or immunosuppressant potential of such drugs. Our goal was easily reached, since 69% of the outpatients visiting our Institute are chronic BZ consumers and because neurochemical, hormonal, immunological, and psychiatric investigations are routinely performed on all of our patients. In the present study, immune function was investigated on two occasions: while the patient was on active medication and 15 days after discontinuation. We concluded that chronic consumption of BZ provokes significant immunological disorders that should be further investigated. Said disorders could not be linked to a pre-existing affective disease or psychosis, since we only selected those BZ users in whom psychiatric investigations ruled out a past or present history of major psychiatric disease.     

Neurological correlates of reward responding in adolescents with and without externalizing behavior disorders.

Opposing theories of striatal hyper- and hypodopaminergic functioning have been suggested in the pathophysiology of externalizing behavior disorders. To test these competing theories, the authors used functional MRI to evaluate neural activity during a simple reward task in 12- to 16-year-old boys with attention-deficit/hyperactivity disorder and/or conduct disorder (n = 19) and in controls with no psychiatric condition (n = 11). The task proceeded in blocks during which participants received either (a) monetary incentives for correct responses or (b) no rewards for correct responses. Controls exhibited striatal activation only during reward, shifting to anterior cingulate activation during nonreward. In contrast, externalizing adolescents exhibited striatal activation during both reward and nonreward. Externalizing psychopathology appears to be characterized by deficits in processing the omission of predicted reward, which may render behaviors that are acquired through environmental contingencies difficult to extinguish when those contingencies change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavior analysis in intellectual and developmental disabilities.

Individuals with intellectual and developmental disabilities (IDD) have deficits in adaptive behavior, slow rates of learning, and behavior disorders that interfere with learning or place them or others at risk. Since the 1960s, researchers and clinicians in the field of applied behavior analysis have used methods based on principles of learning to increase adaptive behavior and decrease the occurrence of behavior disorders of individuals with IDD. This article provides an overview of assessment and treatment strategies used in behavior analysis to effect positive changes in the quality of life for individuals with IDD and presents an illustrative case study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sommeil, insomnie et psychopathologie.

Sleep plays a critical role in psychological well-being and adaptation. Not surprisingly, sleep disturbance is a frequent problem among individuals facing situational psychological difficulties as well as among those with more chronic psychopathology. This article examines the relationship among sleep, insomnia, and psychopathology. In the first section, we address the issue of comorbidity by examining prevalence rates of sleep disturbances in the general population and among subgroups of individuals with selected psychopathologies and, conversely, rates of psychological symptoms/syndromes among individuals with and without sleep disturbances. The data indicate high rates of psychological syndromes (40%) associated with insomnia among community-based samples, and even higher rates (80%) of sleep disturbances among selected samples of patients with psychopathology. Comorbidity is particularly high among patients with insomnia, major depression, and generalized anxiety disorder. Although insomnia is often a symptom of an underlying psychopathology, longitudinal studies show that it can also be an important risk factor for a new onset major depressive disorder. The second section of this article summarizes the main subjective and EEG sleep impairments in selected anxiety disorders, mood disorders, and schizophrenia. Insomnia is a common clinical feature or even a diagnostic criterion of several of those disorders. Other related symptoms such as fatigue, low energy and poor concentration are shared across insomnia, major depression, and generalized anxiety disorder, suggesting some common mechanisms among those conditions. In addition to subjective sleep complaints, there is also evidence of EEG sleep abnormalities, such as impairment of sleep continuity, reduced slow wave sleep, and altered REM sleep patterns, with the latter two features being more specific to mood disorders. The third section of this article examines the effects of insomnia treatment on co-existing psychological symptoms or disorders and, conversely, the effects of treatment of selected anxiety and mood disorders on sleep. These results indicate that treatments of depression and anxiety may produce some sleep improvements but, in many cases, residual sleep disturbances persist and may actually increase the risk of subsequent relapse. The main implication is that treatment should directly target both co-existing conditions. Additional implications for the treatment and prevention of comorbid sleep disturbances and psychopathology and for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

On the application of genetic expectancies as age-specific base rates in the study of human behavior disorders.

"The long recognized tendency of many abnormal behavior patterns to run in families may prove useful in understanding, predicting, and controlling such behavior, regardless of whether the ultimate cause lies in social heredity or in biological heredity and regardless of the extent to which these are correlated." The writers suggest that it is now possible to determine age-specific statements of probability that various disorders will develop in various subpopulations which should be studied longitudinally to discover the differences between those Ss who develop the disorder and those who do not. Examples of the uses of genetic expectancies are given. 25 references. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-based psychological treatments for disruptive behaviors in individuals with dementia.

In this article, the authors review the literature regarding evidence-based psychological treatments (EBTs) for behavioral disturbances in older adults with dementia, as proposed by the American Psychological Association's Committee on Science and Practice of the Society for Clinical Psychology. Fifty-seven randomized clinical trials were reviewed for inclusion on the basis of titles or abstract information. Forty-three were excluded either because they did not meet EBT methodological criteria or because they involved environmental or psychoeducational nursing interventions in which the psychological component could not be separately evaluated. Fourteen studies were considered for inclusion as EBTs; of these, 8 showed significant differences between treatment and control groups. Results of this review indicate that behavioral problem-solving therapies that identify and modify antecedents and consequences of problem behaviors and increase pleasant events and individualized interventions based on progressively lowered stress threshold models that include problem solving and environmental modification meet EBT criteria. Additional randomized clinical trials are needed to evaluate the generalizability and efficacy of these and other promising psychological interventions in a variety of settings with individuals who have a range of cognitive, functional, and physical strengths and limitations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychoneuroimmunology and HIV-1.

Recent psychoneuroimmunologic findings have suggested that it may be useful to evaluate the influence of behavioral factors on immune functioning and disease progression among human immunodeficiency virus-Type 1 (HIV-1) infected individuals. Behavioral interventions with immunomodulatory capabilities may help restore competence and thereby arrest HIV-1 disease promotion at the earliest stages of the infectious continuum. Evidence describing benefits of behavioral interventions such as aerobic exercise training on both psychological and immunological functioning among high-risk HIV-1 seronegative and very early stage seropositive gay men is presented. The HIV-1 infection is cast as a chronic disease for which early immunomodulatory behavioral interventions may have important physical and psychological impact. (PsycINFO Database Record (c) 2010 APA, all rights reserved)