Measures Of Symptom Severity Research Articles

Examining posttraumatic stress disorder as a predictor of treatment response to dialectical behavior therapy.

This study examined the presence of posttraumatic stress disorder (PTSD) as a predictor of treatment response to dialectical behavior therapy (DBT) across the primary outcomes of interest within DBT (i.e., borderline personality disorder [BPD] symptoms, deliberate self-harm, emotion regulation [ER] difficulties) and PTSD symptoms. Participants (N = 56) were consecutive admissions to an outpatient DBT clinic that completed diagnostic interviews at intake and self-report outcome measures at intake and every 3 months throughout the treatment. Patients with (vs. without) a PTSD diagnosis did not report greater clinical severity at intake on most outcome measures, with the exception of PTSD symptom severity and, among older patients only, ER difficulties. The presence of a PTSD diagnosis was not associated with poorer treatment response to DBT. Instead, PTSD was associated with better response on the measure of BPD symptom severity. The results suggest that patients with PTSD can benefit from DBT.

Are working memory and glutamate concentrations involved in early-life stress and severity of psychosis?

ObjectiveOccurrences of early‐life stress (ELS) are associated with the severity of psychotic symptoms and working memory (WM) deficits in patients with psychosis (PSY). This study investigated potential mediation roles of WM behavioral performance and glutamate concentrations in prefrontal brain regions on the association between ELS and psychotic symptom severity in PSY.MethodForty‐seven patients with PSY (established schizophrenia, n = 30; bipolar disorder, n = 17) completed measures of psychotic symptom severity. In addition, data on ELS and WM performance were collected in both patients with PSY and healthy controls (HC; n = 41). Resting‐state glutamate concentrations in the bilateral dorsolateral prefrontal cortex (DLPFC) and anterior cingulate cortex (ACC) were also assessed with proton magnetic resonance spectroscopy for both PSY and HC groups. t tests, analyses of variance, and regression analyses were utilized.ResultsParticipants with PSY reported significantly more ELS occurrences and showed poorer WM performance than HC. Furthermore, individuals with PSY displayed lower glutamate concentrations in the left DLPFC than HC. Neither ELS nor WM performance were predictive of severity of psychotic symptoms in participants with PSY. However, we found a significant negative correlation between glutamate concentrations in the left DLPFC and ELS occurrence in HC only.ConclusionIn individuals with PSY, the current study found no evidence that the association between ELS and psychotic symptoms is mediated by WM performance or prefrontal glutamate concentrations. In HC, the association between ELS experience and glutamate concentrations may indicate a neurometabolite effect of ELS that is independent of an illness effect in psychosis.

Physical activity, sleep and neuropsychiatric symptom severity in children with tourette syndrome.

The purpose of this study was to examine associations between physical activity, sleep and symptom severity in children with tic disorders. Children with tic disorders wore the GeneActiv device, a wrist-worn accelerometer that measures physical activity intensity and sleep/wake parameters continuously for seven days, and completed questionnaires on sleep quality, exercise and severity of tics, ADHD, obsessive-compulsive behaviours, anxiety and depression. 110 children participated in the study. Children with more severe tics had significantly more frequent comorbid diagnoses, greater impairment in subjective sleep measures, greater sedentary activity time and less light, moderate and vigorous activity time (all p < 0.05). There was a significant negative correlation between light, moderate and vigorous physical activity and the severity of tics (- 0.22, p = 0.04), obsessive compulsive behaviours (- 0.22, p = 0.03), anxiety (- 0.35, p = 0.0005) and depression (- 0.23, p = 0.03). There was no correlation between objective sleep time, sleep efficiency and symptom severity. Subjective sleep quality was positively correlated with all symptom severity measures, with the strongest correlation with ADHD severity (0.42, p < 0.00001). The results of this observational study indicate a small, but significant relationship between activity and sleep measures and the severity of the main symptom domains present in tic disorders.

Scale-free functional brain dynamics during recovery from sport-related concussion.

Studies using blood‐oxygenation‐level‐dependent functional magnetic resonance imaging (BOLD fMRI) have characterized how the resting brain is affected by concussion. The literature to date, however, has largely focused on measuring changes in the spatial organization of functional brain networks. In the present study, changes in the temporal dynamics of BOLD signals are examined throughout concussion recovery using scaling (or fractal) analysis. Imaging data were collected for 228 university‐level athletes, 61 with concussion and 167 athletic controls. Concussed athletes were scanned at the acute phase of injury (1–7 days postinjury), the subacute phase (8–14 days postinjury), medical clearance to return to sport (RTS), 1 month post‐RTS and 1 year post‐RTS. The wavelet leader multifractal approach was used to assess scaling () and multifractal () behavior. Significant longitudinal changes were identified for , which was lowest at acute injury, became significantly elevated at RTS, and returned near control levels by 1 year post‐RTS. No longitudinal changes were identified for . Secondary analyses showed that clinical measures of acute symptom severity and time to RTP were related to longitudinal changes in . Athletes with both higher symptoms and prolonged recovery had elevated values at RTS, while athletes with higher symptoms but rapid recovery had reduced at acute injury. This study provides the first evidence for long‐term recovery of BOLD scale‐free brain dynamics after a concussion.

Rasch analysis of the PANSS negative subscale and exploration of negative symptom trajectories in first-episode schizophrenia – data from the OPTiMiSE trial

The observed heterogeneity in negative symptom treatment response may be partly attributable to inadequate measurement tools or limitations in methods of analysis. Previous Item Response Theory models of the Positive and Negative Syndrome Scale (PANSS) have only examined samples of chronic patients and with mixed results. We examined the scalability of the negative subscale embedded in the PANSS and subsequently explored negative symptom trajectories across four weeks of amisulpride treatment. Data were derived from the OPTiMiSE trial comprising 446 patients with first-episode schizophrenia or schizophreniform disorder. Using the Rasch Model to examine psychometric properties of the PANSS negative subscale, we found that the composite score across items was not an adequate measure of negative symptom severity. Consequently, we chose an exploratory statistical approach involving Principal Component Analysis which yielded one significant component clustering into two significant symptom trajectories: 1) Subtle but constant decrease in negative symptom severity (N = 323; 72%), and 2) symptom instability across visits (N = 19; 4%). Explorative analytic methods as presented here may pave the way for more efficient and sensitive methods of analyzing negative symptom response in research and in clinical practice.

Individual and Gender Differences in Personality Influence the Diagnosis of Major Depressive Disorder.

In order to explore whether gender differences are present in self-reports on personality measures when all Major Depressive Disorder (MDD) participants are diagnosed at an equal intensity, the aim of this study was to investigate individual and gender differences in personality between healthy participants and those suffering from severe feature MDD. The sample consisted of 632 participants: 385 in the healthy control group and 247 MDD, the latter comprised of patients in their first diagnosed episode or recurrent. The Hamilton Depression Rating Scale (HAM-D) was used to measure symptom severity. Beck's Depression Inventory was administered when depression symptoms had lessened, establishing it as minor when filling out the personality questionnaire (NEO-PI-R). The results indicate a broad difference in personality between the healthy control and the MDD groups. High neuroticism and low extraversion, accompanied by low scores on openness and conscientiousness, were the most important personality dimensions in understanding distinctions. While agreeableness did not indicate any important role, it did significantly influence the understanding of gender differences within groups. Females were found more agreeable in both groups, but those from the healthy group were also more open and conscientiousness than healthy males. Females from the MDD group were found to be also higher on neuroticism than males of the same group. A general conclusion from the study is that personality dimensions are more important in understanding vulnerability to depression in comparison to gender differences in personality within groups. As females in the MDD group tend to self-report higher levels of agreeableness and neuroticism than do males in the same group when the level of their depression is categorized as equal MDD-severe type, this may influence practitioners to unequally diagnose depression in males and females.

Validation of Abbreviated Four- and Eight-Item Versions of the PTSD Checklist for DSM-5 in a Traumatically Injured Sample.

Rates of posttraumatic stress disorder (PTSD) are three times higher in traumatically injured populations than the general population, yet limited brief, valid measures for assessing PTSD symptom severity exist. The PTSD Checklist for DSM-5 (PCL-5) is a valid, efficient measure of symptom severity, but its completion is time consuming. Subsequently, abbreviated four- and eight-item versions were developed using the Mini-International Neuropsychiatric Interview-7 PTSD module and validated in Veteran samples. This study aimed to validate these abbreviated versions using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), the gold standard for PTSD diagnosis, in a traumatically injured civilian population. Participants were 251 traumatically injured adults (Mage = 42.52 years; 69.3% male; 50.2% Caucasian) recruited from a Level 1 trauma center inpatient unit; 32.3% and 17.9% of participants experienced a motor vehicle crash or gunshot wound, respectively. The CAPS-5 and PCL-5 were administered approximately 6.5 months postinjury. We examined whether compared to the full PCL-5, the abbreviated versions would adequately differentiate between participants with and without a CAPS-5 PTSD diagnosis. The abbreviated versions were highly correlated with the total scale and showed good-to-excellent internal consistency. The diagnostic utility of the abbreviated measures was comparable to that of the total scale regarding sensitivity, suggesting they may be useful as abbreviated screening tools; however, the total scale functioned better regarding specificity. The abbreviated versions of the PCL-5 may be useful screening instruments in the long-term care of traumatic injury survivors and may be more likely to be implemented across routine clinical and research contexts.

Discriminant and convergent validity of the GSRS-IBS symptom severity measure for irritable bowel syndrome: A population study.

The Gastrointestinal Symptom Rating Scale-Irritable Bowel Syndrome (GSRS-IBS) is a 13-item measure of IBS symptom severity. The scale has been used in several studies, but its psychometric properties have been insufficiently investigated and population-based data are not available. The objective of this article is to establish the factor structure and discriminant and convergent validity of the GSRS-IBS. The study was based on a Swedish population sample (the Popcol study), of which 1158 randomly selected participants provided data on the GSRS-IBS. We used confirmatory factor analysis (CFA) and compared total and subscales scores in different groups, including IBS diagnostic status, treatment-seeking behavior, and predominant bowel habits. The GSRS-IBS scores were also correlated with quality of life indexes. The sample included 164 participants with a confirmed Rome III IBS diagnosis and 994 participants without the disease. The CFA confirmed the subscales with one exception, in which the incomplete bowel-emptying item belonged to the constipation subscale rather than the diarrhea subscale. The GSRS-IBS total score and subscales were associated with diagnostic status, treatment-seeking behavior, and quality of life dimensions. The relevant subscales scores also differed between the diarrhea- and constipation-predominant subtypes of IBS. The GSRS-IBS total score and subscales have high discriminant and convergent validity. The CFA confirmed the overall validity of the subscales but suggest that a sense of incomplete emptying belongs to the constipation rather than the diarrhea symptom cluster. We conclude that the GSRS-IBS is an excellent measure of IBS symptom severity in the general population.

A brief, residential peer‐support retreat for trichotillomania: A mixed methods evaluation

Evidence‐based psychological treatments for trichotillomania (TTM) can be effective; however, relapse is common and consumers have indicated poor satisfaction with treatment outcomes. The aim of this study was to identify participants' perspectives of critical factors associated with short‐ and long‐term recovery following their brief, intensive peer‐support retreat for TTM. A mixed methods longitudinal design was used to evaluate a 3‐day residential peer‐support retreat attended by eight women who self‐referred into the retreat. Semi‐structured interviews were conducted at post‐retreat (n = 6) and 12‐month follow‐up (n = 5). Self‐report measures of symptom severity, mood and quality of life were completed at baseline (n = 7), post‐retreat (n = 6), 6‐month follow‐up (n = 5) and 12‐month follow‐up (n = 5). An inductive thematic analysis was performed to identify themes within the interview transcripts. Quantitative outcome data was used to confirm, challenge, provide context for, and link qualitative findings within the broader literature. Quantitative outcome data demonstrated reduced TTM severity from baseline to post‐retreat. By 6‐month follow‐up, symptoms had relapsed to baseline levels. Participants' perspectives of factors associated with recovery immediately after the retreat included group‐based processes (e.g., sharing, normalisation, safety, and enhanced motivation/accountability) and individual processes (e.g., readiness for change, self‐regulation skills). The qualitative and quantitative data conveyed similar outcomes at both post‐retreat and 12‐month follow‐up. Brief, immersive peer‐support retreats for TTM may facilitate equivalent symptom reductions as longer, therapist‐delivered cognitive behavioural treatments for some individuals.

Group education, night splinting and home exercises reduce conversion to surgery for carpal tunnel syndrome: a multicentre randomised trial.

In people with carpal tunnel syndrome who are waitlisted for surgical consultation, does a therapist-led care pathway involving education, splinting and exercises reduce the need for surgery and improve patient outcomes? A multicentre, randomised controlled trial with concealed allocation, blinded assessment and intention-to-treat analysis. One hundred and five people with electrodiagnostically confirmed carpal tunnel syndrome on a waitlist for surgical consultation and recruited from four public hospitals in Australia. The experimental group (n= 52) received a one-off group session of education, splinting, and nerve and tendon gliding exercises. The control group (n= 53) continued on the waitlist without additional care. The primary outcome measures were conversion to surgery by 24 weeks, the global rating of change (GROC) scale and patient satisfaction. Secondary outcomes included symptom severity and functional limitation. At 24 weeks, conversion to surgery was 59% in the experimental group and 80% in the control group (risk difference-0.21, 95% CI-0.38 to-0.03). More participants in the experimental group identified as improved at 6 weeks (20% vs 4%; risk difference 0.15, 95% CI 0.03 to 0.28) but not at 24 weeks (24% vs 10%; risk difference 0.14, 95% CI-0.01 to 0.29). The intervention was also estimated to be beneficial on some measures of satisfaction, symptom severity and functional limitation. The study's estimates of the benefits came with some uncertainty, which makes it unclear whether the wider population of people awaiting carpal tunnel surgery would consider that the benefits make the intervention worthwhile. No serious adverse effects were reported. A therapist-led pathway reduced conversion to carpal tunnel surgery and increased perceived improvement and satisfaction in people who were already on a waitlist for surgical consultation. ACTRN12613001095752.

A randomized clinical trial of mindfulness-based cognitive therapy for women with irritable bowel syndrome-Effects and mechanisms.

Irritable bowel syndrome (IBS) is a chronic disorder of brain-gut interaction. Previous studies suggest that mindfulness could be therapeutic for IBS patients, however no study has evaluated the effects of mindfulness-based cognitive therapy adapted for patients with IBS (MBCT-IBS). A 6-week MBCT-IBS course was designed to reduce symptoms and increase quality of life. This study aimed to evaluate the effects of MBCT-IBS and to investigate its therapeutic mechanisms in a randomized controlled trial. Sixty-seven female patients with IBS were randomized to MBCT-IBS (MG; n = 36) or a waitlist (WL; n = 31) control condition. Patients completed standardized self-report measures of IBS symptom severity, IBS quality of life, maladaptive illness cognitions (catastrophizing, visceral anxiety sensitivity) and mindfulness at baseline, after 2 treatment sessions, at posttreatment, and at 6-week follow-up. Self-referential processing of illness and health was measured with an implicit association test (IAT). The MG reported significantly greater reductions in IBS symptoms (p = .003) and improvements in quality of life (p < .001) at follow-up compared with the WL. Changes in visceral anxiety sensitivity and pain catastrophizing at posttreatment and reductions in the IAT-score after 2 sessions combined with increases in nonjudgmental awareness at posttreatment mediated reductions in IBS symptoms. MBCT-IBS has the potential to reduce IBS symptoms and increase quality of life. MBCT-IBS may exert its effect on IBS symptoms via reducing maladaptive illness cognitions and activating changes in self-processing (reducing biases in self-referent processing of illness and health and increasing nonjudgmental awareness). (PsycINFO Database Record (c) 2020 APA, all rights reserved).

THE UTILITY AND VALIDATION OF THE FREQUENCY OF CONCUSSION SYMPTOMS (FOCS) QUESTIONNAIRE

Background:Individuals with concussion show elevated scores on symptom checklists as long as the impairment is detectable (Peterson et al., 2003). The research question was to examine whether a questionnaire based on concussion symptom frequency (FOCS) would demonstrate sensitivity and specificity in differentiating concussion from non-concussion and provide beneficial clinical data when added to symptom severity measures such as the PCSS.Purpose:The purpose of this study was to determine the clinical utility of concussion symptom frequency using the Frequency of Concussion Symptoms (FOCS) Questionnaire in a sample of pediatric patients.Methods:Pediatric patients ages 13-18 diagnosed with a concussion (n=250) and orthopedic controls (n=250) presenting to an outpatient orthopedic clinic were administered the FOCS and PCSS at the time of initial clinical evaluation. All patients were administered the FOCS and PCSS by certified athletic trainers who were educated and trained on administration. The Frequency of Concussion Symptoms (FOCS) Questionnaire is a self-report measure consisting of 28 items, rated on a 5-point scale from 4 (constantly) to 0 (never). The PCSS is a self-report measure consisting of 22 items rated on a 7-point scale from 0 (none) to 6 (severe). Demographic data were summarized using descriptive statistics. Point estimates and 95% confidence intervals were calculated for all end points. Pearson correlations were calculated based on numerical values from the FOCS and PCSS data to establish validity. A regression analysis was performed to examine the coefficient of determination for FOCS and PCSS scores.Results:The total concussion sample consisted of 103 females and 147 males (mean age=15.03, SD=1.38), the orthopedic control sample consisted of 92 females and 158 males (mean age=15.46, SD=1.12). There was a positive correlation between the FOCS and PCSS in concussion patients (r=0.73, p=0.002) and in orthopedic controls (r=0.68, p=<0.001). Concussion and orthopedic control samples were not correlated on the FOCS (r=0.09, p<0.001) and PCSS (r=0.21, P=0.02). Multiple regression analysis was used to measure FOCS and PCSS scores in concussion patients (R2=0.78, p=<0.001).Conclusions:This is the first study of its kind examining concussion symptom frequency and severity to improve clinical symptom reporting. Adding frequency to symptom severity accounted for 78% of the variance. This may be the result of less subjectivity in frequency versus severity. This study was limited by sample size, further research is warranted to explore the relationship between symptom frequency and severity.

Childhood Cat Bites Relate to Increased Adulthood Severity of Schizotypy, Psychotic-Like Experiences, and Social Anhedonia in a Transdiagnostic Psychiatric Sample

Introduction: Previous research has linked childhood cat scratches and bites to an increased risk for depression, and childhood cat ownership to increased risk of schizophrenia, bipolar disorder, and social anhedonia. Our group previously reported that childhood cat bites, but not ownership, related to increased schizotypy severity in an undergraduate sample. Methods: The current study expands this research by inquiring about cat bites and ownership in a transdiagnostic adult sample (N = 162; 51% female; mean age = 38.15, SD = 10.65), composed of schizophrenia spectrum disorders (n = 30), bipolar disorders (n = 30), unipolar depression (n = 23), and nonpsychiatric participants (n = 79). Participants completed a diagnostic interview, scales of symptom severity, and a cat interaction history interview. Results: Across the entire sample, self-report of cat bites prior to age 13, but not after, related to greater current severity of overall schizotypy, self-reported and clinician-rated psychotic-like symptoms, and social anhedonia, when compared to individuals who reported no lifetime cat bites. Cat bites prior to age 13 did not relate to severity of depression, non-social anhedonia, or clinician-rated negative symptoms. Self-report of residing with a cat prior to age 13, or a first cat bite after age 12, did not relate to any symptom severity measure examined. Conclusions: One theory for these findings is that an unknown infectious agent common in cat saliva interacted with brain development in childhood to increase the likelihood of these symptoms. A novel theory for the infectious agent Pasteurella multocidais discussed. Future research can examine candidate infectious agents to identify potential causal mechanisms for these relationships.

Reliability, validity, and the ability to detect change of the Psoriasis Symptom Scale (PSS) in patients with plaque psoriasis

Introduction: The primary objective of the study was to evaluate the measurement properties of the patient-reported four-item Psoriasis Symptom Scale (PSS).Methods: Analysis of phase-III data on the efficacy of risankizumab to assess psychometric characteristics of the PSS in patients with moderate-to-severe psoriasis.Results: PSS items had a good range of symptom severity coverage. The PSS had good test–retest reliability (ICCs >0.90). Convergent and discriminant validity was indicated by moderate-to-strong correlations between the PSS and Dermatology Life Quality Index (DLQI), PSS pain item and EQ-5D pain/discomfort item at week 12 (0.63), and moderate negative correlation with EQ-Visual Analog Scale score at week 12 (−0.37). Known groups validity demonstrated as mean PSS total scores varied by Psoriasis Area and Severity Index (PASI) and Static Physician’s Global Assessment (sPGA) defined groups (p < .0001). PSS total scores were responsive to changes in PASI score (p < .0001) and sPGA (p < .0001). PSS minimal, clinical, and meaningful change is estimated to be 1 to 2 points; a preliminary responder definition is a total change score of 3 to 4 points.Conclusions: The PSS is a short, valid unidimensional measure of psoriasis symptom severity, well suited for use in clinical trials.

Clinical judgement, case complexity and symptom scores as predictors of outcome in depression: an exploratory analysis

BackgroundClinical guidelines for depression in adults recommend the use of outcome measures and stepped care models in routine care. Such measures are based on symptom severity, but response to treatment is likely to also be influenced by personal and contextual factors. This observational study of a routine clinical sample sought to examine the extent to which “symptom severity measures” and “complexity measures” assess different aspects of patient experience, and how they might relate to clinical outcomes, including disengagement from treatment.MethodsSubjects with symptoms of depression (with or without comorbid anxiety) were recruited from people referred to an established Primary Care Mental Health Team using a stepped care model. Each participant completed three baseline symptom measures (the Personal Health Questionnaire (PHQ), Generalised Anxiety Disorder questionnaire (GAD) and Clinical Outcomes in Routine Evaluation (CORE-10)), and two assessments of “case complexity” (the Minnesota-Edinburgh Complexity Assessment Measure (MECAM) and a local complexity assessment). Clinician perception of likely completion of treatment and patient recovery was also assessed. Outcome measures were drop out and clinical improvement on the PHQ.Results298 subjects were recruited to the study, of whom 258 had a sufficient dataset available for analysis. Data showed that the three measures of symptom severity used in this study (PHQ, GAD and CORE-10) seemed to be measuring distinct characteristics from those associated with the measures of case complexity (MECAM, previous and current problem count). Higher symptom severity scores were correlated with improved outcomes at the end of treatment, but there was no association between outcome and complexity measures. Clinicians could predict participant drop-out from care with some accuracy, but had no ability to predict outcome from treatment.ConclusionsThese results highlight the extent to which drop-out complicates recovery from depression with or without anxiety in real-world settings, and the need to consider other factors beyond symptom severity in planning care. The findings are discussed in relation to a growing body of literature investigating prognostic indicators in the context of models of collaborative care for depression.

Preliminary Evidence of a Dose-Response for Continuing to Play on Recovery Time After Concussion.

To investigate a dose-response relationship between continuing to play following concussion and outcomes. A total of 130 athletes (age 11-19 years). Repeated-measures design comparing symptoms, neurocognitive performance, and recovery time between 52 athletes immediately removed from play (Removed), 24 who continued to play for 15 minutes or less (Short-Play), and 32 who continued to play for more than 15 minutes (Long-Play). Recovery was the number of days from injury to clearance. Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) measured neurocognitive outcomes and the Post-Concussion Symptom Scale (PCSS) measured symptom severity. Long-Play (44.09 ± 27.01 days) took longer to recover than Short-Play (28.42±12.74 days) and Removed (18.98 ± 13.76 days). Short-Play was 5.43 times more likely, and Long-Play 11.76 times more likely, to experience protracted recovery relative to Removed. Both Play groups had worse neurocognitive performance and higher symptom scores than Removed at days 1 to 7, with Long-Play demonstrating worse reaction time than Short-Play. At days 8 to 30, both Play groups performed worse than Removed on visual memory and visual motor speed, while only Long-Play performed worse on verbal memory and reaction time. Results provide initial evidence of a dose-response effect for continuing to play on recovery from concussion, highlighting the importance of removal from play.

Treatment for anxiety: Mindfulness meditation versus escitalopram (TAME): Design of a randomized, controlled non-inferiority trial

Anxiety disorders (generalized anxiety disorder, social anxiety disorder, panic disorder, and agoraphobia) are common, distressing, and impairing. While pharmacotherapy and psychotherapy are first-line treatment strategies for anxiety disorders, many patients are reluctant to take psychiatric medication, and many prefer to avoid any kind of mental health treatment due to stigma or distrust of traditional medical care. We present the trial protocol for the first study comparing first-line medication treatment with Mindfulness-Based Stress Reduction (MBSR), a popular mindfulness meditation training program, for the treatment of anxiety disorders. We will use a non-inferiority, comparative effectiveness trial design, in which individuals with diagnosed anxiety disorders will be randomized to either pharmacotherapy with escitalopram or MBSR for 8 weeks of treatment. Treatment outcome will be based on gold standard symptom severity measures assessed by trained independent evaluators blind to treatment allocation. Secondary outcomes will include key symptom and function measures, as well as tolerability and satisfaction with treatment. Findings will provide crucial information to inform decision making about the relative benefits of MBSR versus a first line medication for anxiety disorders by patients, medical care providers, healthcare insurers and other stakeholders.

Effects of Bergen 4-Day Treatment on Resting-State Graph Features in Obsessive-Compulsive Disorder

BackgroundExposure and response prevention is an effective treatment for obsessive-compulsive disorder (OCD), but it is unclear how symptom reduction is related to changes in the brain. We aimed to determine the effects of a 4-day concentrated exposure and response prevention program (Bergen 4-day treatment) on the static and dynamic functional connectome in patients with OCD. MethodsThirty-four patients with OCD (25 unmedicated) underwent resting-state functional magnetic resonance imaging the day before the Bergen 4-day treatment, and 28 (21 unmedicated) were rescanned after 1 week. Twenty-eight healthy control subjects were also scanned for baseline comparisons and 19 of them were rescanned after 1 week. Static and dynamic graph measures were quantified to determine network topology at the global, subnetwork, and regional levels (including efficiency, clustering, between-subnetwork connectivity, and node flexibility in module allegiance). The Yale-Brown Obsessive Compulsive Scale was used to measure symptom severity. ResultsTwenty-four patients (86%) responded to treatment. We found significant group × time effects in frontoparietal-limbic connectivity (ηp2 = 0.19, p = .03) and flexibility of the right subgenual anterior cingulate cortex (ηp2 = 0.18, p = .03), where, in both cases, unmedicated patients showed significant decreases while healthy control subjects showed no significant changes. Healthy control subjects showed increases in global and subnetwork efficiency and clustering coefficient, particularly in the somatomotor subnetwork. ConclusionsConcentrated exposure and response prevention in unmedicated patients with OCD leads to decreased connectivity between the frontoparietal and limbic subnetworks and less flexibility of the connectivity of the subgenual anterior cingulate cortex, suggesting a more independent and stable network topology. This may represent less limbic interference on cognitive control subnetworks after treatment.

The Work and Social Adjustment Scale, Youth and Parent Versions: Psychometric Evaluation of a Brief Measure of Functional Impairment in Young People

The Work and Social Adjustment Scale (WSAS) is a brief global measure of functional impairment that is widely used in adult health. We have adapted the WSAS for its use in youth, the WSAS-Youth version (WSAS-Y) and WSAS-Parent version (WSAS-P). This study evaluated the psychometric properties of the scale. The internal consistency, factor structure, convergent and divergent validity, test–retest reliability and sensitivity to change of the WSAS-Y/P were studied in 525 children and adolescents with obsessive–compulsive disorder and related disorders receiving treatment. The internal consistency of the WSAS-Y/P was excellent across diagnostic groups and time-points. Exploratory factor analysis extracted a single-factor of functional impairment, explaining in excess of 85% of the variance. The test–retest reliability was adequate. The WSAS-Y/P correlated more strongly with other measures of functional impairment than with measures of symptom severity, indicating good convergent/divergent validity. Finally, the WSAS-Y/P was highly sensitive to change after treatment.

Race Differences in the Effect of Subjective Social Status on Hostility and Depressive Symptoms Among 9- to 11-Year-Old Children.

Research shows that subjective social status (SSS) is a salient determinant of health. However, there is little research on SSS-related group differences on psychosocial outcomes among children. The purpose of the current study was to determine if associations between psychosocial functioning and SSS in children varied as a function of racial groups. We used a series of regression models to examine associations between SSS and measures of hostility and depressive symptom severity in groups of Black and White children. All analyses controlled for objective markers of family- and neighborhood-level socioeconomic status. Participants included 291 school-age children in Syracuse, NY. Among Black children, SSS was negatively associated with hostility scores, R2 = 0.10, F(6, 160) = 3.34, p = 0.006, but not depressive symptom severity. Conversely, among White children, SSS was negatively associated with depressive symptom severity, R2 = 0.18, F(6, 117) = 4.37, p = 0.001, but not hostility. These racial differences in SSS-associated psychosocial functioning could be explained by race-based differences in attributions of social mobility and socioeconomic inequalities. Findings provide support for investigating possible tailoring of behavioral interventions to assist children in developing high SSS or coping with low SSS.