Collateral Report Research Articles

Discrepancies in perceptions of PTSD symptoms among veteran couples: Links to poorer relationship and individual functioning.

Veteran and intimate partner perceptions of posttraumatic stress disorder (PTSD) may differ, and little is known about how agreement or disagreement on symptom severity is related to relationship satisfaction. Veterans and their partners (N = 199 couples) completed a baseline assessment for a clinical trial evaluating two couple-based PTSD interventions. Veterans completed the PTSD Checklist for DSM-5 (PCL-5). Partners completed the collateral PCL-5 (PCL-5-C), which asked them to rate the severity of the veteran's PTSD symptoms. Both partner and veteran completed the Couples Satisfaction Index (CSI-32). Intraclass correlations (ICC) assessed agreement between PCL-5 and PCL-5-C total and subscale scores, which was low for total PCL and for all subscales (ICC = 0.15-0.46). Actor-Partner Interdependence Models (APIMs; actor-only pattern) tested associations between relationship satisfaction and PTSD symptom severity (total PCL and subscales), and the magnitude and direction of difference between PCL-5 and PCL-5-C (total and subscales). For veterans, more severetotal PTSD and negative cognition/mood scores were associated with lower relationship satisfaction, and the direction of discrepancy for negative cognition/mood (i.e., higher veteran-rated PTSD symptoms relative to partner's collateral report) was also associated with lower satisfaction. For partners, more severe collateral-reported symptoms for total PTSD and all four subscales were associated with lower relationship satisfaction; further, a larger discrepancy between veterans' and partners' reports of total PTSD, negative cognition/mood, and hyperarousal were associated with lower satisfaction. These results suggest that partners may have different perceptions of PTSD symptoms, and support the potential of fostering a shared understanding of PTSD symptom severity in couples.

A - 94 A Case of New Onset Refractory Status Epilepticus (NORSE) Associated with COVID-19.

New Onset Refractory Status Epilepticus (NORSE) is a rare condition of prolonged medication-refractory seizures potentially due to elevated inflammatory molecules in the brain. NORSE can be triggered by a viral infection and is a documented neurologic consequence of COVID-19. A 74-year-old, left-handed, Hispanic male was in his usual state of health until experiencing 1-2weeks of speech decline, which culminated in an episode of altered mental status (disorientation and mumbling speech). He presented to the Emergency Department with drowsiness and complaints of a "funny feeling" on the left side of his head. Upon arrival, he was found to be COVID-19 positive and hyperglycemic with normal CT, MRI, lumbar puncture, and bloodwork. An EEG showed "focal temporal activity" and he was diagnosed with non-convulsant status epilepticus. Hospitalization and medical sedation lasted 2months followed by 8months of inpatient rehabilitation. The patient was discharged shortly before presenting for neuropsychological evaluation. Neuropsychological evaluation showed weaknesses in learning and free recall, visuospatial skills (due to disorganization and poor attention to details), processing speed, and executive functioning. The patient reported elevated anxiety symptoms. Collateral report indicated severe declines in executive organizational abilities, as well as mild memory and divided attention declines. Results suggest frontal cortical and subcortical impairments affecting multiple areas of cognition and functional decline consistent with a diagnosis of major neurocognitive disorder. Similar to the literature, status epilepticus was attributed to inflammatory meningoencephalitis triggered by the prior COVID-19 infection. Interdisciplinary care was an integral factor in this case.

B - 24 Neuropsychological Profile of a Child with ASD, ADHD, and Psychotic Features.

Autism Spectrum Disorder (ASD), Attention Deficit-Hyperactivity Disorder (ADHD), and psychotic traits, although highly comorbid, have rarely been studied in children. Existing research indicates that impulsivity, comprehension difficulties, and inflexibility are overlapping symptoms within the ASD and ADHD populations. Adult research shows high comorbidity estimates between ASD and psychosis. Here we describe the neuropsychological profile of a 14-year-old boy with diagnoses of ASD and ADHD with psychotic features. We highlight the value of comprehensive and flexible neuropsychological assessment while integrating detailed testing, behavioral observations, and collateral report. Medical history of this child included late-term and breech birth with his first Apgar score at expected level and his second score falling below expected level. Delayed acquisition of developmental milestones, learning difficulties, speech difficulties, anxiety, and hyperactivity, were reported. Auditory hallucinations triggered by stress were observed during evaluation. Comprehensive neuropsychological evaluation requires nonstandard exploration of cognitive domains and time-limited testing sessions to acquire robust estimates of functioning. Overall cognitive abilities were in the borderline range with highly variable academic performances (extremely low to average). All performances were grossly below age level and were significantly impacted by auditory hallucinations but were consistent with the diagnoses of ASD and ADHD. This case of a boy with ASD, ADHD, and auditory hallucinations demonstrates the diagnostic overlap among these conditions and the necessity for flexible neuropsychological testing, detailed behavioral observations and caregiver report in the assessment of overlapping clinical features. Multiple sources of data are required to identify patterns in symptomatology to inform differential diagnosis and comorbidities.

H - 51 Neuropsychological Evaluation of Non-Fluent English Speakers: a Case Study.

Sometimes patients are referred for neuropsychological evaluation who do not speak English as their first language. In many cases, we have declined evaluating patients who were not fluent in English, and when we have evaluated bilingual patients, have qualified the limitations of our interpretations. However, there are no neuropsychologists providing services in languages besides English in the state of Oklahoma, and most patients never received services. Patient is 83-year-old woman with five years of progressive decline in memory, unable to manage instrumental activities of daily living, presenting with family history of Alzheimer's disease, and neuroimaging negative for atrophy or cerebrovascular disease. Patient was not fluent in English. Efforts to find a neuropsychologist able to evaluate in Spanish were unsuccessful, so testing was modified, and measures were administered by a bilingual psychometrist. Attention, orientation, and memory were impaired (MMSE = 14). Verbal fluency was intact in Spanish. Auditory memory was not assessed due to unavailability of Spanish measures. Visual memory was impaired, consistent with figure copy. WAIS-IV was administered in English, with instructions in Spanish. Patient was diagnosed with possible Alzheimer's disease. Recommended PET scan or spinal tap for Alzheimer's disease biomarkers and reevaluation in Spanish in one year. Since neuropsychological evaluation is not available in every language, evaluation in English and highlighting the limitations of our findings may meet the ethical principle of beneficence, if we consider the impact of language and additional sources of data, such as collateral report of the patient's caregivers, and medical tests.

Psychometric Properties of the BAASIS: A Meta-analysis of Individual Participant Data.

Nonadherence to immunosuppressives, a risk factor for poor posttransplant outcomes, can be assessed by self-report using the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS). Available in written and interview versions, and previously validated on content, the BAASIS is widely used in research and clinical practice. The aim of this study was to investigate its psychometric properties. Using a literature search and our BAASIS database, this meta-analysis identified completed studies in adult transplant recipients whose data were usable to examine the BAASIS' reliability and 3 validity aspects: (1) relationships with other variables (electronic monitoring, other self-report scales, tacrolimus blood-level variability, collateral report, depressive symptoms, psycho-behavioral constructs, and interventions); (2) response processes; and (3) internal structure. Testing used random-effects logistic regressions. Our sample included 12 109 graft recipients from 26 studies. Of these 26, a total of 20 provided individual participant data. Evidence of the BAASIS' stability over time supports its reliability. Validity testing of relationships with other variables showed that BAASIS-assessed nonadherence was significantly associated with the selected variables: electronically monitored nonadherence ( P < 0.03), other self- and collaterally-reported nonadherence ( P < 0.001), higher variability in tacrolimus concentrations ( P = 0.02), higher barriers ( P < 0.001), lower self-efficacy ( P < 0.001), lower intention ( P < 0.001), and higher worries ( P = 0.02). Nonadherence also decreased after regimen change interventions ( P = 0.03). Response process evaluation indicated good readability and slightly higher nonadherence with the written version. Structurally, items on taking and timing shared variability. The BAASIS shows good validity and reliability as a self-report instrument to assess medication nonadherence in transplantation.

Social interactions in trauma disclosure: A multi-informant and multiconstruct investigation.

Research has established that social factors are integral to trauma recovery. Yet, there is relatively little data on the association between social interactions from different supports and posttraumatic stress disorder (PTSD) symptoms. Moreover, few studies have measured these factors from multiple informants. This paper examined social interactions from different sources (i.e., negative and positive reactions from a chosen close other [CO], family/friends, and general non-COs) and their association with PTSD symptoms using multi-informant reports of the social constructs (i.e., from the individual exposed to trauma [TI] and their CO). Participants (N = 104 dyads) were recruited from an urban center within 6 months of the TIs' exposure to a traumatic event. TIs were assessed using the Clinician-Administered PTSD Scale. TI self-report, t(97) = 2.58, p = .012, and CO collateral report of disapproval from family/friends, t(97) = 2.14, p = .035, and TI self-report of general disapproval, t(97) = 4.91, p < .001, emerged as significant predictors of PTSD symptoms when compared with other social constructs. Interventions that target family members' and friends' reactions to trauma survivors and societal discourse around trauma and reactions to trauma survivors are recommended. Clinical interventions that buffer against TIs' experiences of disapproval and guide COs on the provision of supportive responses are discussed.

Everyday Functioning and Entorhinal and Inferior Temporal Tau Burden in Cognitively Normal Older Adults.

Performance of cognitively complex "instrumental activities of daily living" (IADL) has previously been related to amyloid deposition in preclinical Alzheimer's disease. We aimed to investigate the relationship between IADL performance and cerebral tau accumulation in cognitively normal older adults. Cross-sectional. Data was collected in the Anti-Amyloid Treatment in Asymptomatic Alzheimer's (A4) and Longitudinal Evaluation of Amyloid Risk and Neurodegeneration (LEARN) studies. Participants (n = 447, age 71.9±4.9 years, 57.5% female) who underwent tau positron emission tomography were selected from the A4 and LEARN studies. IADL performance was measured using the self- and study partner-reported versions of the Alzheimer's Disease Cooperative Study Activities of Daily Living - Prevention Instrument (ADCS ADL-PI). We also investigated discordance between participants and their study partners. Cross-sectional associations between entorhinal and inferior temporal tau (independent variables) and ADCS ADL-PI total scores, item-level scores and discordance (dependent variables) were investigated in linear and logistic regressions. Analyses were adjusted for age, sex and education and a tau by amyloid interaction was also included. Participants and their study partners reported high levels of IADL performance. Entorhinal and inferior temporal tau were related to study partner but not to self-reported total ADCS ADL-PI scores. The association was not retained after adjustment for global cerebral amyloid burden. At the item level, greater entorhinal tau was associated with study partner-reported difficulties remembering important dates (odds ratio (OR) = 1.24, 95% confidence interval (95%CI) = [1.06, 1.45], p = 0.008) and difficulties remembering the details of TV programs and movies (OR = 1.32, 95%CI = [1.08, 1.61], p = 0.007). Greater inferior temporal tau was associated with self-reported difficulties managing to find personal belongings (OR = 1.23, 95%CI = [1.04, 1.46], p = 0.018) and study partner-reported difficulties remembering the details of TV programs and movies (OR = 1.39, 95%CI = [1.11, 1.75], p = 0.005). Discordance between participant and study partner-report was more likely with greater entorhinal (OR = 1.18, 95%CI = [1.05, 1.33], p = 0.005) and inferior temporal tau burden (OR = 1.29, 95%CI = [1.10, 1.51], p = 0.002). We found a cross-sectional relationship between study partner-reported everyday functioning and tau in cognitively normal older adults. Participants were more likely to self-report difficulties differently from their study partners when tau burden was higher. This may hint at an altered early-disease awareness of functional changes and underscores the importance of self-report of IADL functioning in addition to collateral report by a study partner.

An Observational Study of the Morning and Evening Behavior of Individuals With and Without Attention-Deficit/Hyperactivity Disorder

As individuals with ADHD move to young adulthood, the morning and evening times become of increased importance. Sixty individuals were enrolled in a 14-day study (30 with ADHD and 30 did not have ADHD). Participants provided self-reports of ADHD symptoms and impairment using ecological momentary assessments administered each morning and each evening. Participants also identified a collateral who could provide daily ratings of the participant during the same time. Driving data were also passively collected. Results indicated differences in self and collateral ratings of ADHD symptoms and impairment, with greater symptom endorsement and reports of impairment for the individuals with ADHD. Self-report indicated greater endorsement in the evening, relative to the morning, for individuals with ADHD. Collateral report did not interact with time of day. Passive evaluation of driving performance was not significantly different. Results indicate young adult ADHD symptoms and impairment can be reliably assessed in the morning/evening. Public Health Significance Evidence of ADHD symptoms and impairments were documented in the morning and evening hours for individuals diagnosed with ADHD. These results illustrate additional areas in need of attention in the refinement of treatments for adults with ADHD.

Assessing posttraumatic stress disorder with close others' collateral reports: Convergence with self- and clinician reports.

Although multisource assessment of posttraumatic stress disorder (PTSD) is considered best practice, past studies have either compared convergence between clinician interview and self-report or self- and close other collateral report of PTSD symptoms without clinician interview. Familial and interpersonal relationships are consistently found to be associated with an individual's psychological recovery following a traumatic event. Thus, it is important to understand the extent to which close others' collateral reports converge with clinician and self-reports of PTSD. This study compared self-, collateral, and clinician reports of PTSD symptom severity. Recently trauma-exposed individuals (N = 117) were assessed using the Clinician-Administered PTSD Scale (CAPS; Blake et al., 1995) and completed the past-month PTSD Checklist-Specific Stressor (PCL; Weathers, Litz, Herman, Huska, & Keane, 1993). Close others (N = 117) completed the PCL for close others (PCL-CO; Monson, 2012) that assessed their perceptions of the trauma-exposed individual's PTSD symptoms. There were significant positive correlations among PCL, PCL-CO, and CAPS total and symptom cluster scores (rs = .36-.80). Correlations were significantly stronger between clinician and self-report ratings than self-report and collateral ratings. The weakest correlations were between the PCL and PCL-CO assessing hyperarousal symptoms, r = .36, p < .01, and CAPS and PCL-CO assessing intrusive symptoms, r = .37, p < .01. Self-report measures may provide reliable PTSD assessment when clinician semistructured assessment is unfeasible. Convergence between close others' collateral and clinician and collateral and self-assessment was comparatively weak. Hyperarousal and intrusive symptoms may be more difficult for collaterals to observe and report. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

M34. NETWORK STRUCTURE OF PROBAND-COLLATERAL DISCREPANCIES IN PSYCHOSIS SPECTRUM

BackgroundObtaining information from multiple informants (family members, parents and/or teachers) is considered ideal practice in clinical psychiatry and is an essential component of child and adolescent psychiatric care. Evidence consistently show reports from different informants differ which affects validity and reliability of the information obtained. Such discrepancies may be due the nature of psychopathology, sociodemographic factors, cultural factors and is dependent on the informant. Examining differences in informant reports can provide clinically pertinent information with the greatest discrepancy potentially providing critical information. This study aimed to quantify proband-collateral discrepancies in psychopathology symptoms and assess network structure of such discrepancies across psychopathology domains.MethodsThe sample (n = 5094) was extracted from the Philadelphia Neurodevelopmental Cohort, a community-based youth sample focusing on participants between 11–17 years of age with both proband and collateral ratings. The following analyses was conducted for this study. First, proband-collateral agreements were examined across psychopathology domains. Intra-class correlations, kappa’s, sensitivity, specificity, positive predictive values, negative predictive values were used to examine proband-collateral agreement. Second, for subjects who met criteria for psychosis spectrum, network structure was estimated to obtain multivariate structural associations (edge weights and strength) among disagreement scores calculated across psychopathology domains. Relative importance of a node in the network was evaluated by centrality indices. Robustness of findings were assessed by accuracy of edge weights and centrality indices.ResultsCorrelations between overall psychosis symptom scores for proband and collateral report was low at 0.26, with probands (mean10.2 + 12.65) endorsing more and severe symptoms than collateral informants (mean 2.82 + 6.31). Intraclass correlation coefficient for psychosis spectrum domain was poor (0.23). Psychosis spectrum items had the lowest kappa’s, ranging from 0.03 to 0.25.Of the total sample, 273 subjects met criteria for psychosis spectrum. Across 14 nodes (psychopathology domains of ADD, OCD, conduct disorder, agoraphobia, social anxiety, panic disorder, depression, mania, PTSD, separation anxiety, ODD, psychosis spectrum, generalized anxiety disorder and general phobia) and 76 potential edges, a very sparse network structure was observed for psychosis spectrum. This network only had two connected positive edges- disagreement scores in depression and mania with the strongest positive edge indicating the greater the disagreements in depression scores, greater was the disagreements in mania reports. Network structure for subjects who reported symptoms of delusion (n=273) was also sparse but with 3 connected edges- Disagreements for ADD and ODD, general phobia and agoraphobia, and panic disorder and OCD. Network structure for subjects who reported hallucinations (n=586) showed a highly interconnected network with positive edges, the strongest edge was between disagreements in ADD and ODD. This seemed to mimic network structure for other psychopathology conditions.DiscussionPsychosis spectrum appear to have distinct network patterns of disagreements between probands and collaterals. This likely point to differences in psychopathology for psychosis spectrum in comparison to other diagnostic conditions. Such discrepancies could potentially be leveraged for early identification.

T76. RETROSPECTIVE ADHD SYMPTOMS IN EARLY PSYCHOSIS: RELATION TO CURRENT CLINICAL SYMPTOMS AND PSYCHOSOCIAL FUNCTIONING

BackgroundIndividuals with psychosis have a 2–5 times higher prevalence of ADHD than the general population. Individuals with early psychosis (EP) with an ADHD history have poorer premorbid social and role functioning, a more challenging symptom course, and poorer long-term psychosocial outcomes. The high degree of overlap in cognitive profiles for both psychosis and ADHD highlights a need for additional research. This project sought to assess the relation between historical report of childhood ADHD symptoms, current psychosis symptoms, and psychosocial functioning in individuals with EP. It is hypothesized that ADHD symptoms will significantly predict functioning.MethodsIndividuals, aged 12–30, who experienced the onset of psychotic symptoms in the past 2 years and presented for care at UC Davis EP clinics, were consented and enrolled. Individuals provided retrospective self-report ratings of childhood (between ages 5–12) symptoms of ‘inattention’ and ‘hyperactivity/impulsivity’ on the Barkley ADHD Rating Scale. Raters coded current psychosocial (Global Social/Role Functioning [GSF/GRF]) and clinical functioning ([Brief Psychiatric Rating Scale [BPRS], Scale for Assessment of Positive [SAPS] and Negative [SANS] Symptoms) at presentation. BPRS, SAPS, and SANS ratings were combined into ‘reality distortion,’ ‘poverty,’ and ‘disorganization’ domains. Medical chart review will be conducted to identify historical report of ADHD diagnosis. Multiple linear regression was used to examine relative contribution of demographic variables, clinical symptoms, and self-reported childhood ADHD symptoms to current social and role functioning.ResultsNinety-eight participants (20.22 years ± 3.95; 39% female; 37% non-Hispanic White; 27% Hispanic; 2% missing demographics) provided complete data. Childhood inattention, poverty, and disorganized symptoms predicted current GSF (R-squared = .39, F[5, 92] = 11.92, p < .001). When assessing demographic differences on outcomes, GSF was rated significantly higher in non-Hispanic White (M = 7.03, SD = 1.80) compared to other non-White participants (M = 6.28, SD = 1.64; t[94] = -2.08, p = .04). With the inclusion of race as a predictor, only poverty and disorganization predicted GSF (R-squared = .40, F[6, 89] = 10.04, p < .001). Poverty symptoms predicted current GRF, while childhood ADHD and other psychosis symptoms did not predict GRF (R-squared = .31, F[5, 92] = 8.09, p < .001). Age significantly correlated with GRF (r = -.31, p = .002). Poverty remained a significant predictor of GRF after including age (R-squared = .37, F[6, 89] = 8.84, p < .001). Additional cognitive correlates, collateral report of childhood ADHD symptoms, prior diagnoses, date of psychosis illness onset, and medication history will also be examined.DiscussionSocial functioning was predicted by childhood self-rated inattention and current negative and disorganized symptoms; however, the relation with childhood inattention did not remain after controlling for race/ethnicity. Additional analyses will be conducted to assess if race is presenting as a proxy for other social determinants, including insurance designation, in this sample. Individuals with ADHD experience more difficulty in social settings compared to typically developing peers, possibly due to increased need to use environmental cues; for individuals who go on to develop psychosis, these childhood events are possibly perceived as more stressful, adding to risk for psychosis. However, it is unclear if self-report childhood inattention – captured here as a putative symptom of ADHD – may be better accounted for by premorbid cognitive impairment associated with risk for psychosis. Additional research is required to establish this connection.

A Multi-method Investigation of the Personality Correlates of Functional Ability in Older Adults

ABSTRACT Objectives This study evaluated the role of personality in predicting functional ability (FA) in older adults using self-report, collateral report, and performance-based measures of FA. Methods Participants included older adults (N = 131) who completed a personality measure (NEO-FFI), a self-report of FA (OARS ADL), and participated in a performance-based assessment of FA (DAFS-R). In addition, each participant had a collateral complete a collateral report of FA (OARS ADL). Bivariate correlations were computed to assess how Five Factor Model traits were related to self-report, collateral, and performance-based measures of FA. Results Neuroticism was negatively related to self-reported FA (r = − .27) and collateral-reported FA (r = − .18) and Conscientiousness was positively related to self-reported FA (r = .25). None of the traits were significantly related to the performance-based measure of FA. Conclusions These results suggest that personality traits can impact self-reported FA in older adults and underscore the importance of assessing FA in older adults using multiple methods, particularly performance-based measures. Clinical Implications Clinicians should consider how personality may impact FA in older adults and multiple methods of FA performance should be examined to better tailor recommendations.

Concordance of Self- and Partner-Reported Alcohol Consumption Among Couples Experiencing Intimate Partner Violence in Zambia.

Hazardous alcohol use is a predictor of intimate partner violence (IPV), and both are increasingly prevalent in sub-Saharan Africa. The accurate measurement of alcohol consumption is therefore critical in IPV intervention studies that target hazardous drinking. Collecting a collateral report in addition to self-report is one convergent validity approach to improve alcohol measurement. We investigated concordance between self- and partner-reported alcohol use among women who reported recent IPV and their male partners in Zambia. Data were from the baseline of a randomized IPV intervention trial of 247 heterosexual couples in which a woman has reported recent IPV and her male partner has recent hazardous alcohol use. Both partners completed the Alcohol Use Disorders Identification Test (AUDIT) in reference to their own drinking and in reference to their partner's drinking. We calculated percent agreement across a range of outcomes: any use, quantity, frequency, and hazardous use. We also compared self- and partner-reported AUDIT scores using t-tests. Concordance was poor across most outcomes. Percent agreement with respect to the women's drinking ranged from 60% to 65% across outcomes and with respect to the men's drinking from 51% to 89%. Women's average partner-reported AUDIT score (20.7) was statistically significantly (p<0.0001) higher than men's average self-reported score (15.8). In contrast to collateral report studies conducted in the United States, concordance between self- and partner-reported alcohol consumption was poor among families experiencing IPV in Zambia. Given the possible biases associated with self-reported alcohol use, findings suggest that a convergent validity approach is useful in this research context.

C-04 Cognitive Status, Tau levels, and Depression in Older Adults

Abstract Objective Worsening cognitive status has been related to depression in older adults. The purpose of this study was to examine the relation between cognitive status and depression and whether this relation was dependent upon tau levels, a biomarker for brain pathology related to Alzheimer’s disease (AD) and other dementias. Method This study consisted of 507 older adults with a mean age of 74. Participants were 40.9% female and 93.9% Caucasian. Neuropsychological assessments, collateral report, and clinician ratings were used to classify each participant by their cognitive status (i.e., cognitively normal (CN), early mild cognitive impairment (MCI), late MCI, or AD). Depression was based on the total score of the Geriatric Depression Scale (GDS). A hierarchical multiple regression was used to analyze the amount of variance explained in depression scores, controlling for age. Results There was a significant relation between cognitive status and GDS, with cognitive status explaining 2.8% of the variance (R-squared = .028, p &lt; .001). Tau explained .6% of the variance in depression scores above and beyond what was explained by cognitive status and age (p = .089). The interaction between cognitive status and tau explained .4% of the variance in depression scores, ΔR-squared = .004, p = .160. Conclusions While this suggests cognitive status and depression may not be dependent upon tau levels in this sample, further research should be done to determine whether other sensitive measures of brain pathology, such as the ratio between phosphorylated tau and total tau, may be relevant in the prediction and diagnosis of depression in individuals with varying levels of cognitive status.

Sluggish Cognitive Tempo in Adults Referred for an ADHD Evaluation: A Psychometric Analysis of Self- and Collateral Report

Objective: Sluggish cognitive tempo (SCT) symptoms uniquely contribute to psychiatric and functional outcomes in child samples; however, the psychometric properties of SCT measures among adult outpatients are unknown. Method: Adults (n = 124) presenting for an ADHD evaluation provided self- and collateral report of SCT symptoms. Results: The SCT scale had good internal consistency and yielded three factors across raters: Slow/Daydreamy, Sleepy/Sluggish, and Low Initiation/Persistence. SCT scores exhibited convergent validity with ADHD symptoms across raters. Individuals with ADHD received higher SCT ratings than those without ADHD via collateral report, a pattern that was similar when comorbidity was considered. SCT was associated with poorer functioning after accounting for ADHD symptoms with some differential effects based on reporting source. Conclusion: Findings support the internal consistency and validity of a three-factor SCT scale among adult outpatients. Differential results between self- and collateral report demonstrate the importance of multiple reporters of SCT in clinical settings.

Twins’ Agreement on Negative and Positive Life Experiences

Most studies of life experiences rely on retrospective self-reports due to the major advantages of this method of data collection. However, some clinicians and researchers express doubts regarding the reliability of self-reports about lived experiences. One option to explore reliability is to assess two or more sources of information, a procedure usually labeled agreement, which consists of the comparison of a self-report (main participant) and a collateral report, to assess whether both reporters describe the same experiences (concordance) and/or to explore whether the collateral confirms the experiences reported by the main participant (corroboration). We studied concordance and corroboration of positive and negative life experiences in 47 pairs of adult twins (N = 94), both genders, 18–50 years of age; 32 pairs were monozygotic. Participants were asked about their own life experiences (to assess concordance) and about their twin’s life experiences (to assess corroboration). Overall agreement between twins was quite acceptable, although it was heterogeneous across items and/or domains. For instance, physical abuse presented a moderate kappa for concordance, while sexual abuse achieved a poor kappa. Corroboration presented globally higher kappa than concordance, suggesting that twins seem to be especially good source of collateral information. Remarkably, when valence (i.e., positive vs. negative experiences) was analyzed, concordance and corroboration were higher for positives experiences than for negative ones. Our results suggest that self- and collateral-reports are reliable means of assessing life experiences, which has important implications for future research.

Self-efficacy beliefs, locus of control, religiosity and non-adherence to immunosuppressive medications in kidney transplant patients.

Adherence to immunosuppressive medication is essential for favourable kidney transplant outcomes. The present study aims to investigate how self-efficacy beliefs, health locus of control and religiosity are associated with adherence to immunosuppressives in post kidney transplant recipients. This is a cross-sectional study with 88 recipients with more than 1 year after transplantation. Three methods were used to classify patients as adherent or non-adherent: Basel Assessment of Adherence Scale for Immunosuppressives - BAASIS, the collateral report and blood levels of immunosuppressive medications. Self-efficacy, health locus of control, and religiosity were evaluated applying General Perceived Self-Efficacy Scale, Multidimensional Health Locus of Control Scale and Duke University Religion Index, respectively. Non-adherence was modelled by uni- and multivariated analysis. Sixty-three percent of the patients were male, age 47.2 ± 12.9 years, and median post-transplant time 108.71 (49.0-266.0) months. We found 70.5% of patients were non-adherent through at least one method. Adherent patients presented higher self-efficacy scores (45.1 ± 4.9 vs 38.3 ± 8.6; P < 0.001) and higher intrinsic religiosity (14.0 ± 1.6 vs. 12.8 ± 2.5; P = 0.016) compared to the non-adherents. Organizational and non-organizational religiosity did not differ between these groups. By logistic regression, non-adherence was associated with lower self-efficacy (OR 0.81, IC 0.70-0.92, P = 0.002), chance locus of control (OR 1.23, IC 1.04-1.45, P = 0.016) and lower intrinsic religiosity (OR 0.56, IC 0.38-0.84, P = 0.006). Our study showed that self-efficacy, chance locus of control, and intrinsic religiosity were associated with non-adherence to immunosuppressives. A broader perception of the kidney transplant patient´s integrality can help health professionals to design strategies to promote adherence in this population.

Trauma exposure and sleep disturbance in a sample of youth from the National Child Traumatic Stress Network Core Data Set

ObjectiveAdverse childhood experiences are prevalent and have been associated with sleep disturbance. However, there are limited data examining factors that influence this relationship. The purpose of this study was to extend the current literature by characterizing the relationship between adverse childhood experiences and sleep disturbance in a sample of trauma-exposed youth and to identify factors that may influence this relationship. Study designData were collected from 56 mental health centers across the National Child Traumatic Stress Network. For the current study, secondary data analysis was conducted using de-identified data from the National Child Traumatic Stress Network Core Data Set. The present study included 4043 children and adolescents who met eligibility criteria. ResultsSixteen percent of the sample (n=634) met criteria for a sleep disturbance as determined through clinician assessment and collateral report. Posttraumatic stress disorder (PTSD) symptom severity influenced the risk of disturbed sleep (ages 7-12: t=−4.33, ages 13-18: t=−7.12, P≤.001 for both analyses), with those meeting full criteria for PTSD at greatest risk (age 7-12: odds ratio [OR]=1.95; 95% confidence interval [CI], 1.17-3.24; age 13-18: OR=3.18; 95% CI, 1.87-5.43). Exposure to sexual assault and community violence also contributed independently to the risk of disturbed sleep (age 7-12, sexual assault: OR=1.76; 95% CI, 1.21-2.57; age 13-18, community violence: OR=1.61; 95% CI, 1.19-2.18). ConclusionsComprehensive treatment strategies should include assessment of disturbed sleep in youth exposed to trauma, particularly those with elevated PTSD symptoms and exposure to sexual trauma or community violence.

Multilevel Correlates of Non-Adherence in Kidney Transplant Patients Benefitting from Full Cost Coverage for Immunosuppressives: A Cross-Sectional Study.

BackgroundAdherence is the result of the interaction of the macro, meso, micro, and patient level factors. The macro level includes full coverage of immunosuppressive medications as is the case in Brazil. We studied the correlates of immunosuppressive non-adherence in post kidney transplant patients in the Brazilian health care system.MethodsUsing a cross-sectional design, adherence to immunosuppressives was assessed in a sample of 100 kidney transplant patients using a composite non-adherence score consisting of three methods (self-report [i.e., The Basel Adherence Scale for Assessment of Immunossupressives–BAASIS], collateral report, and immunosuppressive blood levels). Multilevel correlations of non-adherence were assessed (macro, meso, micro and patient level). Univariate and multivariate logistic regression was applied to assess the correlates of non-adherence.ResultsOur sample consisted primarily of male (65%), Caucasians (72%) with a mean age of 45.0 ± 13.5 years old, who received grafts from a living donor (89%), with a mean time after transplantation of 72.3 ± 44.4 months. Prevalence of non-adherence was 51%. Family income higher than five reference wages (21.6 vs. 4%; OR 6.46 [1.35–30.89], p = 0.009; patient level), and having access to private health insurance (35.3% vs. 18.4%; OR 2.42 [0.96–6.10], p = 0.04; meso level) were associated with non-adherence in univariate analysis. Only the higher family income variable was retained in the multiple logistic regression model (OR 5.0; IC: 1.01–25.14; p = 0.04).ConclusionsHigher family income was the only factor that was associated with immunosuppressive non-adherence. In Brazil, lower income recipients benefit from better access to care and coverage of health care costs after transplantation. This is supposed to result in a better immunosuppressive adherence compared to high-income patients who have experienced these benefits continuously.

Does collateral retrospective information about childhood attention-deficit/hyperactivity disorder symptoms assist in the diagnosis of attention-deficit/hyperactivity disorder in adults? Findings from a large clinical sample.

In accordance with consolidated clinical practice, Diagnostic and Statistical Manual of Mental Disorders, 5th edition suggests a key role of collateral information in the evaluation of retrospective childhood attention-deficit/hyperactivity disorder symptoms in adults despite poor evidence supporting its use. This study aims to assess the incremental value of collateral information on the presence of childhood attention-deficit/hyperactivity disorder symptoms when evaluating adults with attention-deficit/hyperactivity disorder. Adult patients with attention-deficit/hyperactivity disorder (n = 449) and non-attention-deficit/hyperactivity disorder subjects (n = 143) underwent an extensive clinical assessment based on Diagnostic and Statistical Manual of Mental Disorders, 4th edition criteria. For patients, retrospective collateral information regarding childhood attention-deficit/hyperactivity disorder was obtained and used to sort them into two groups: agreement (n = 277) and disagreement (n = 172) between self- and collateral reports. We compared demographic, clinical and response to treatment profiles among groups to test the relevance of collateral information on the specific issue of childhood attention-deficit/hyperactivity disorder symptoms. Both attention-deficit/hyperactivity disorder groups had higher rates of several comorbidities (oppositional defiant, conduct, substance use and bipolar disorders; all p < 0.001) and impairments than controls. Disagreement between self- and collateral reports on childhood attention-deficit/hyperactivity disorder symptoms occurred in 38% of patients. Overall, attention-deficit/hyperactivity disorder disagreement and agreement groups had similar profiles in response to treatment and comorbidity, and the few differences detected in impairment measures were of small magnitude (Eta(2) < 0.05). Although collateral report has an important role for diagnosing attention-deficit/hyperactivity disorder in children, it has no incremental value in the evaluation of childhood attention-deficit/hyperactivity disorder symptoms in adults with a self-reported history of attention-deficit/hyperactivity disorder assessed in clinical settings.